(1586) Novel Echocardiogram Hydrodynamic Indices Are Associated With Outcome in Pediatric Sepsis

Introduction: Cardiac dysfunction is common in pediatric sepsis and is a key driver of mortality. Echocardiography is commonly used to determine the degree of dysfunction. Multiple indices have been described; however, it is unclear which indices are most important. We sought to describe novel indices based on the hydrodynamic concept of kinetic energy (KE) in the right ventricle (RV). We hypothesized that dysfunction in our indices would be associated with higher morbidity and mortality.

Methods: We performed a retrospective case-control study. Cases were admitted to the pediatric intensive care unit (ICU) with sepsis and who had an echocardiogram performed. Controls were healthy age-matched subjects without a diagnosis of sepsis and with a normal echocardiogram. We examined RV KE indices of intraventricular blood flow during systole and diastole based on Color Doppler Velocity Reconstruction (DoVeR), The quantity KE is a measure of the amount of energy associated with the speed of the moving blood. The reported KE is a quantity integrated over the ventricle, and indexed based on the ventricle area. Our primary outcome was difference in RV KE indices between groups. Secondary outcomes examined in the subset of patients with sepsis included RV KE association with mortality, 28-day composite outcomes, and development of pediatric acute respiratory distress syndrome (ARDS).

Results: Sixty-six children were included (39 cases and 27 controls). The median age of the cohort was 1 (0, 4) year and was not different between cases and controls. Total RV KE was higher in the patients with sepsis [21.9 J/m3 (15.3, 30.2)] vs controls [13.6 J/m3 (9.0, 25.8)], p:0.025. An increase in RV KE systolic peak was associated with higher mortality in those with sepsis (HR: 1.015 (1.003-1.027), p:0.010]. Abnormal RV KE systolic average was associated with 7.8 fewer ventilator free days (p:0.021) and 13.1 fewer ICU free days (p:0.041). Both RV KE systolic average (p:0.041) and RV KE systolic peak (p:0.026) were associated with ARDS development.

Conclusions: In this cohort of children, we have identified multiple novel echocardiogram indices based on the hydrodynamic concept of kinetic energy of the right ventricle that are associated with morbidity and mortality in pediatric sepsis.