Effect of Hemodynamic Management Using the Trend of Perfusion Index in Patients Admitted to the Paediatric Intensive Care Unit

Abstract

Objective: To determine the effect of hemodynamic management using the trend of perfusion index admitted in Paediatrics intensive care unit.
Methodology: A prospective observational study was conducted at Paediatrics Intensive Care unit, Indus Hospital, Karachi. Children admitted in PICU with shock, aged between 2 months to 14 years and both genders were included. A questionnaire was utilized to collect data, including patient baseline demographics and clinical information. Hemodynamic management typically employed for patients with low peripheral perfusion or shock, involved fluid resuscitation and/or inotropic support. The perfusion index, derived from pulse oximetry, measures peripheral perfusion noninvasively by calculating the ratio of pulsatile to non-pulsatile blood flow in peripheral tissues. Statistical package for the social sciences (SPSS v. 26) was used for data entry and analysis.
Results: A total of 80 patients were studies with a overall mean age of 6.34+3.23 years. The primary causes of admission were respiratory failure 41.7% and septic shock 33.3%, and others 16.7%. Patients showed a significant improvement in PI
(from 0.8 ± 0.3 to 1.5 ± 0.4, p = 0.001 after management, along with stabilization of systolic and diastolic BP and decrease in heart rate (p = 0.001). Mortality was highest among patients admitted for septic shock 30% compared to other causative factors
40%, while those with respiratory failure had better outcomes 91.7% discharged. Correlation analysis revealed a strong positive relationship between improvements in PI and survival (p=0.001).
Conclusion: Study revealed that the hemodynamic treatment involving resuscitation and inotropic support among patients in PICU. It played a pivotal role in stabilizing vital signs, as reflected in the significant improvements in perfusion index, blood pressure, and heart rate. The interventions were particularly beneficial in patients with respiratory failure, who showed the highest survival rates, while patients with septic shock and cardiac arrest, required more intensive support, had higher mortality rates.