ELECTROCARDIOGRAPHIC CHANGES IN SEPSIS AND SEPTIC SHOCK IN PEDIATRIC ICU

Abstract

Summary M yocardial dysfunction in severe sepsis and septic shock is well recognized but incompletely understood. Under recognition of these impairments may contribute to significant morbidity and mortality in children if not addressed in a timely fashion. Electrocardiogram (ECG) contains a wealth of diagnostic information routinely used to guide clinical decision making in hospitalized patients. Hence, ECG remains the gold standard for diagnosis in spite of the advance of many other diagnostic techniques. As it is a noninvasive, inexpensive, simple, and reproducible technique. Moreover, it is one of the most commonly used diagnostic tests that can be rapidly recorded with extremely portable equipment and is in general always obtainable. The aim of this study was to test the hypothesis that routine Holter analysis in non cardiac pediatric ICU septic patients could reveal clinically important disturbances that might go undetected. The study was performed at the pediatric intensive care unit at Ain Shams University hospital from January 2014 to January 2015. The present study included 38 patients with sepsis and septic shock fulfilling the inclusion criteria of sepsis and septic shock. All patients were subjected to: 1. Full history taking laying stress on: age, sex, history of repeated infection, co-morbid disease, medication, drug history and family history of cardiac diseases or early sudden deaths. 2. Clinical Examination laying stress on: - Pulse and blood pressure monitoring. - Signs of sepsis and septic shock. - Local cardiac examination and heart rate monitoring. 3. Laboratory investigations: - Full blood count (CBC). - Serum electrolytes (Na, K, Ca, Mg). - C- Reactive protein (CRP). - Serum lactate. - Arterial blood gases. 4. Transthoracic Echocardiography: to exclude congenital or acquired heart disease and to assess cardiac chamber dilatation and function. It was done by using device model GE medical systems VIVID7 dimension N-3190 Horten NORWAY. Two dimensional, M-mode echocardiography examination were performed. 5. ECG and Holter analysis to detect any abnormality in the cardiac rhythm or ischemic ECG changes using Sciller MT-101 Microvit Holter Monitor. 6. The risk of mortality was detected in the studied population by applying the (PRISM) Pediatric risk of mortality score. 7. The collected data was revised, coded, tabulated and introduced to a PC using Statistical package for Social Science (SPSS 15).

More than half of the cases were males (57.9%) and 42.1% were females so that, male sex was found to have more sepsis as compared to female sex. Among the causes of sepsis, the present study showed that pneumonia was the most common precipitating cause for sepsis among all cases (26.3%). Hyperthermia was present in 68.4% of the cases were while the hypothermia was present in 31.6% of the cases. The percentage of cases with leucocytosis was more than those with leucopenia (73.7% versus 26.3%). In the present study, 30 cases (78.9%) had no DIC while 8 cases (21%) had DIC. Moreover, only 11 cases (28.9 %) had developed renal failure while 27 cases (71.1%) had not developed renal failure. 7.9% of cases were complicated by septic encephalopathy and ARDS occurred in 52% of the cases. 24 cases (63.2%) were on mechanical ventilation while 14 cases (36.8%) were not ventilated, 13 of the ventilated cases (54.2%) were on Spontaneous intermittent mandatory ventilation mode (SIMV) while 11 cases (45.8%) were on high frequency mode. The mean CRP level was 60.8 ± 33.3 mg/l ranging from 6 to 112 mg/l. The mean lactate level in our study was 42.86 mg/dl ± 29.54 ranging from 8.1 to 164.9 mg/dl.