Morgan Recher1,2, Astrid Botte3, Jerome Soquet4, Jean-Benoit Baudelet5, François Godart5, Stephane Leteurtre6. 1. ULR 2694 - METRICS : Évaluation des Technologies de santé et des Pratiques Médicales, Univ. Lille, CHU Lille, 59000, Lille, France. morgan.recher@chru-lille.fr. 2. Réanimation et Surveillance Continue Pédiatriques, Hôpital Jeanne de Flandre, CHU de Lille, 59037, Lille Cedex, France. morgan.recher@chru-lille.fr. 3. Pediatric and Neonatal Intensive Care Unit, CHU Bordeaux, 33076, Bordeaux, France. 4. Cardiac Surgery Unit, CHU Lille, 59000, Lille, France. 5. Congenital and Pediatric Cardiology Unit, CHU Lille, 59000, Lille, France. 6. ULR 2694 - METRICS : Évaluation des Technologies de santé et des Pratiques Médicales, Univ. Lille, CHU Lille, 59000, Lille, France.
Abstract
BACKGROUND: The incidence of diastolic heart failure has increased over time. The evaluation of left-ventricular diastolic function is complex, ongoing, and remains poorly performed in pediatric intensive-care patients. This study aimed to review the literature and to provide an update on the evaluation of left-ventricular diastolic function in adults and children in intensive care. DATA SOURCES: We searched data from PubMed/Medline. Thirty-two studies were included. Four pragmatic questions were identified: (1) What is the physiopathology of diastolic dysfunction? (2) Which tools are required to evaluate diastolic function? (3) What are the echocardiographic criteria needed to evaluate diastolic function? (4) When should diastolic function be evaluated in pediatric intensive care? RESULTS: Early diastole allows characterization of relaxation, whereas compliance assessments and filling pressures are evaluated during late diastole. The evolution of diastolic function differs between adults and children. Unlike in adults, decreased compliance occurs at the same time as delayed relaxation in children. Diastolic function can be evaluated by Doppler echocardiography. The echocardiographic criteria for ventricular relaxation include the E wave, E/A wave ratio, and isovolumic relaxation time. Ventricular compliance can be assessed by the E/e' wave ratio, atrial volume, and Ap wave duration during pulmonary vein flow. In adult intensive-care patients, the E/e' ratio can be used as an index of tolerance for volume expansion in septic patients and to adjust the inotropic support. CONCLUSION: Clinical studies would allow some of these parameters to be validated for use in children in intensive care.
BACKGROUND: The incidence of diastolic heart failure has increased over time. The evaluation of left-ventricular diastolic function is complex, ongoing, and remains poorly performed in pediatric intensive-care patients. This study aimed to review the literature and to provide an update on the evaluation of left-ventricular diastolic function in adults and children in intensive care. DATA SOURCES: We searched data from PubMed/Medline. Thirty-two studies were included. Four pragmatic questions were identified: (1) What is the physiopathology of diastolic dysfunction? (2) Which tools are required to evaluate diastolic function? (3) What are the echocardiographic criteria needed to evaluate diastolic function? (4) When should diastolic function be evaluated in pediatric intensive care? RESULTS: Early diastole allows characterization of relaxation, whereas compliance assessments and filling pressures are evaluated during late diastole. The evolution of diastolic function differs between adults and children. Unlike in adults, decreased compliance occurs at the same time as delayed relaxation in children. Diastolic function can be evaluated by Doppler echocardiography. The echocardiographic criteria for ventricular relaxation include the E wave, E/A wave ratio, and isovolumic relaxation time. Ventricular compliance can be assessed by the E/e' wave ratio, atrial volume, and Ap wave duration during pulmonary vein flow. In adult intensive-care patients, the E/e' ratio can be used as an index of tolerance for volume expansion in septic patients and to adjust the inotropic support. CONCLUSION: Clinical studies would allow some of these parameters to be validated for use in children in intensive care.
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