Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 1;23(6):e295-e299.
doi: 10.1097/PCC.0000000000002954. Epub 2022 Mar 31.

Vasoplegic Shock Represents a Dominant Hemodynamic Profile of Multisystem Inflammatory Syndrome Following COVID-19 in Children and Adolescents

Alexander Alali  1 , Erika O'Neil  2 , Marc Anders  2 , Jayvee Abella  3 , Lara S Shekerdemian  2 , Tiphanie P Vogel  4 , Kristen Sexson Tejtel  1 , Sebastian C Tume  2
Affiliations

Vasoplegic Shock Represents a Dominant Hemodynamic Profile of Multisystem Inflammatory Syndrome Following COVID-19 in Children and Adolescents

Alexander Alali et al. Pediatr Crit Care Med. .

Abstract

Objectives: The hemodynamic profile of multisystem inflammatory syndrome in children (MIS-C)-related shock remains poorly defined and, therefore, challenging to support with pharmacotherapy in the ICU. We aimed to evaluate the hemodynamic profile and vasoactive medication management used in MIS-C patients presenting to the ICU in shock and provide data from high-fidelity continuous cardiac output monitoring.

Design: Single-center retrospective case-cohort study.

Setting: Pediatric and cardiac ICU in a quaternary-care hospital.

Patients: All patients who met U.S. Centers for Disease Control and Prevention criteria for MIS-C and who were admitted to the ICU between March 2020 and May 2021 required vasoactive support and were placed on continuous cardiac index (CCI) monitoring. Patients requiring extracorporeal life support were excluded.

Interventions: None.

Measurements and main results: Among 52 children with MIS-C presenting in shock and requiring vasoactive support, 14 patients (27%) were placed on CCI monitoring. These 14 patients had hyperdynamic cardiac index (CI) and low indexed systemic vascular resistance (SVRi) in the first 24 hours with normalization of CI and improved SVRi within the subsequent 24 hours.

Conclusions: Further studies are needed to evaluate the difference between the use of vasoconstrictor versus vasodilators in pediatric patients with MIS-C because a phenotype with high CI and low SVRi may be important.

PubMed Disclaimer

Conflict of interest statement

Dr. Vogel received support for article research from the NIH (R61HD105593). She disclosed the off-label product use of anakinra for rare hyperinflammatory condition. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Hemodynamic progression of the 14 patients with continuous cardiac index (CCI) monitoring beginning at the start of CCI measurement. First row = There is initial hyperdynamic cardiac output and a low systemic vascular resistance index (SVRi) state (second row) within the first 24 hr with normalization of CI and improved, but still low, SVRi in the next 24 hr (p < 0.001 for both). Third row = Similarly, this cohort required high vasoactive support initially with a decrease over time. CI = cardiac index, MIS-C = multisystem inflammatory syndrome in children, VIS = vasoactive-inotropic score.
See this image and copyright information in PMC

References

    1. Valverde I, Singh Y, Sanchez-de-Toledo J, et al. ; AEPC COVID-19 Rapid Response Team*: Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation 2021; 143:21–32 - PubMed
    1. Feldstein LR, Rose EB, Horwitz SM, et al. ; Overcoming COVID-19 Investigators; CDC COVID-19 Response Team: Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383:334–346 - PMC - PubMed
    1. Centers for Disease Control and Prevention: CDC Health Alert Network. Emergency Preparedness and Response: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated With Coronavirus Disease 2019 (COVID-19). Health Advisory. 2020. Available at: https://emergency.cdc.gov/han/2020/han00432.asp. Accessed September 2, 2021
    1. Eytan D, Goodwin AJ, Greer R, et al. : Heart rate and blood pressure centile curves and distributions by age of hospitalized critically ill children. Front Pediatr 2017; 5:52. - PMC - PubMed
    1. Gaies MG, Gurney JG, Yen AH, et al. . Vasoactive–inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass*. Pediatr Crit Care Med 2010; 11:234–238 - PubMed

Publication types

Supplementary concepts