. 2022 Jan 1;149(1 Suppl 1):S39-S47.

doi: 10.1542/peds.2021-052888F.

Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Peta M A Alexander^{1

2}, Paul A Checchia³, Lindsay M Ryerson⁴, Desmond Bohn⁵, Michelle Eckerle⁶, Michael Gaies⁷, Peter Laussen^{1

8}, Howard Jeffries⁹, Ravi R Thiagarajan^{1

2}, Lara Shekerdemian³, Melania M Bembea¹⁰, Jerry J Zimmerman¹¹, Niranjan Kissoon¹²; Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Collaborative

Collaborators, Affiliations

Collaborators

Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Collaborative:
Michael Agus, Ayse Akcan-Arikan, Rajit Basu, Tellen D Bennett, Leonardo R Brandão, Ann-Marie Brown, Joseph A Carcillo, Jill Cholette, Ira M Cheifetz, Timothy Cornell, Allan Doctor, Simon Erickson, Reid W D Farris, E Vincent S Faustino, Julie C Fitzgerald, Dana Y Fuhrman, John S Giuliano Jr, Kristin Guilliams, Stephen M Gorga, Mark Hall, Sheila J Hanson, Mary Hartman, Amanda B Hassinger, Sharon Y Irving, Philippe Jouvet, Sujatha Kannan, Oliver Karam, Robinder G Khemani, Jacques Lacroix, Francis Leclerc, Jan Hau Lee, Stephane Leteurtre, Katie Lobner, Patrick J McKiernan, Kusum Menon, Paul Monagle, Jennifer A Muszynski, Folafoluwa Odetola, Robert Parker, Nazima Pathan, Richard W Pierce, Jose Pineda, Jose M Prince, Karen A Robinson, Courtney M Rowan, L. Nelson Sanchez-Pinto, Luregn J Schlapbach, David T Selewski, Dennis Simon, Lincoln S Smith, James E Squires, Robert H Squires, Scott M Sutherland, Yves Ouellette, Michael C Spaeder, Vijay Srinivasan, Marie E Steiner, Robert C Tasker, Neal Thomas, Pierre Tissieres, Chani Traube, Marisa Tucci, Katri V Typpo, Mark S Wainwright, Shan L Ward, R Scott Watson, Scott Weiss, Jane Whitney, Doug Willson, James L Wynn, Nadir Yehya

Affiliations

¹ Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
² Departments of Pediatrics.
³ Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
⁴ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
⁵ Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁶ Department of Pediatrics, College of Medicine, University of Cincinnati and Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁷ Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
⁸ Anesthesia, Harvard Medical School, Harvard University, Boston, Massachusetts.
⁹ Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.
¹⁰ Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
¹¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital and Harborview Medical Center and School of Medicine, University of Washington, Seattle, Washington.
¹² Division of Critical Care, Department of Pediatrics, The University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada.

PMID: 34970677
PMCID: PMC9745438
DOI: 10.1542/peds.2021-052888F

Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Peta M A Alexander et al. Pediatrics. 2022.

. 2022 Jan 1;149(1 Suppl 1):S39-S47.

doi: 10.1542/peds.2021-052888F.

Authors

Collaborators

Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Collaborative:
Michael Agus, Ayse Akcan-Arikan, Rajit Basu, Tellen D Bennett, Leonardo R Brandão, Ann-Marie Brown, Joseph A Carcillo, Jill Cholette, Ira M Cheifetz, Timothy Cornell, Allan Doctor, Simon Erickson, Reid W D Farris, E Vincent S Faustino, Julie C Fitzgerald, Dana Y Fuhrman, John S Giuliano Jr, Kristin Guilliams, Stephen M Gorga, Mark Hall, Sheila J Hanson, Mary Hartman, Amanda B Hassinger, Sharon Y Irving, Philippe Jouvet, Sujatha Kannan, Oliver Karam, Robinder G Khemani, Jacques Lacroix, Francis Leclerc, Jan Hau Lee, Stephane Leteurtre, Katie Lobner, Patrick J McKiernan, Kusum Menon, Paul Monagle, Jennifer A Muszynski, Folafoluwa Odetola, Robert Parker, Nazima Pathan, Richard W Pierce, Jose Pineda, Jose M Prince, Karen A Robinson, Courtney M Rowan, L. Nelson Sanchez-Pinto, Luregn J Schlapbach, David T Selewski, Dennis Simon, Lincoln S Smith, James E Squires, Robert H Squires, Scott M Sutherland, Yves Ouellette, Michael C Spaeder, Vijay Srinivasan, Marie E Steiner, Robert C Tasker, Neal Thomas, Pierre Tissieres, Chani Traube, Marisa Tucci, Katri V Typpo, Mark S Wainwright, Shan L Ward, R Scott Watson, Scott Weiss, Jane Whitney, Doug Willson, James L Wynn, Nadir Yehya

Affiliations

¹ Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
² Departments of Pediatrics.
³ Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
⁴ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
⁵ Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁶ Department of Pediatrics, College of Medicine, University of Cincinnati and Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁷ Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
⁸ Anesthesia, Harvard Medical School, Harvard University, Boston, Massachusetts.
⁹ Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.
¹⁰ Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
¹¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital and Harborview Medical Center and School of Medicine, University of Washington, Seattle, Washington.
¹² Division of Critical Care, Department of Pediatrics, The University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada.

PMID: 34970677
PMCID: PMC9745438
DOI: 10.1542/peds.2021-052888F

Abstract

Context: Cardiovascular dysfunction is associated with poor outcomes in critically ill children.

Objective: We aim to derive an evidence-informed, consensus-based definition of cardiovascular dysfunction in critically ill children.

Data sources: Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020 using medical subject heading terms and text words to define concepts of cardiovascular dysfunction, pediatric critical illness, and outcomes of interest.

Study selection: Studies were included if they evaluated critically ill children with cardiovascular dysfunction and assessment and/or scoring tools to screen for cardiovascular dysfunction and assessed mortality, functional status, organ-specific, or other patient-centered outcomes. Studies of adults, premature infants (≤36 weeks gestational age), animals, reviews and/or commentaries, case series (sample size ≤10), and non-English-language studies were excluded. Studies of children with cyanotic congenital heart disease or cardiovascular dysfunction after cardiopulmonary bypass were excluded.

Data extraction: Data were abstracted from each eligible study into a standard data extraction form, along with risk-of-bias assessment by a task force member.

Results: Cardiovascular dysfunction was defined by 9 elements, including 4 which indicate severe cardiovascular dysfunction. Cardiopulmonary arrest (>5 minutes) or mechanical circulatory support independently define severe cardiovascular dysfunction, whereas tachycardia, hypotension, vasoactive-inotropic score, lactate, troponin I, central venous oxygen saturation, and echocardiographic estimation of left ventricular ejection fraction were included in any combination. There was expert agreement (>80%) on the definition.

Limitations: All included studies were observational and many were retrospective.

Conclusions: The Pediatric Organ Dysfunction Information Update Mandate panel propose this evidence-informed definition of cardiovascular dysfunction.

PubMed Disclaimer

Conflict of interest statement

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

Figures

**Figure 1.**
Study flow diagram according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols recommendations.

See this image and copyright information in PMC

References

1. Jain A, Sankar J, Anubhuti A, et al. Prevalence and Outcome of Sepsis-induced Myocardial Dysfunction in Children with ‘Sepsis’ ‘With’ and ‘Without Shock’-A Prospective Observational Study. J Trop Pediatr 2018;64(6):501–9. - PubMed
1. Ackland GL, Iqbal S, Paredes LG, et al. Individualised oxygen delivery targeted haemodynamic therapy in high-risk surgical patients: a multicentre, randomised, double-blind, controlled, mechanistic trial. Lancet Respir Med 2015;3(1):33–41. - PubMed
1. Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020;21(2):e52–e106. - PubMed
1. Bembea MM, Agus M, Akcan-Arikan A, et al. Pediatric organ dysfunction information update mandate (PODIUM) contemporary organ dysfunction criteria: executive summary. Pediatrics. 2022;149(suppl 1):e2021052888B - PMC - PubMed
1. Topjian AA, de Caen A, Wainwright MS, et al. Pediatric Post-Cardiac Arrest Care: A Scientific Statement From the American Heart Association. Circulation 2019;140(6):e194–e233. - PubMed

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Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Collaborators

Affiliations

Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources