Mortality high in children with pulmonary hypertension admitted to pediatric cardiac ICUs

A new study identified high mortality rates for children with pulmonary hypertension who were admitted to pediatric cardiac ICUs during a 5-year period.

Among 2,602 admissions, the rate of mortality was 10% compared with 3.9% for other medical admissions.

“Previous literature from the general pediatric ICU population suggests that children with pulmonary hypertension are at significantly greater risk than children without pulmonary hypertension for mortality, longer lengths of stay and invasive interventions, including CPR, extracorporeal membrane oxygenation and mechanical ventilation,” Emily Morell, MD, pediatric cardiology fellow in the department of pediatrics at the Children’s Hospital Los Angeles, and colleagues wrote in the American Journal of Respiratory and Critical Care Medicine.

The study included children admitted to Pediatric Cardiac Critical Care Consortium institutions from August 2014 to September 2019. Pulmonary hypertension was defined as a clinical diagnosis and/or receipt of ICU care-level pulmonary vasodilator therapy.

Factors strongly associated with mortality in this population included invasive ventilation (adjusted OR = 44.8; 95% CI, 6.2-323), CPR (aOR = 8.9; 95% CI, 5.6-14.1) and vasoactive infusions (aOR = 4.8; 95% CI, 2.6-8.8).

Mortality rates were lower among children admitted to pediatric cardiac ICUs who did not receive respiratory support compared with children who did receive invasive mechanical ventilation (1% vs. 20%). Children who received invasive ventilation and vasoactive infusions on days 1 and 2 of admission had higher mortality rates (29.2% and 28.6%, respectively) compared with children who did not receive either treatment (4.8% and 3.2%, respectively).

In addition, mortality was lower in children who received only prostacyclin therapy at the time of ICU admission compared with children who received prostacyclin therapy and nitric oxide during the first hour of ICU admission (1.7% vs. 18.2%).

Vasoactive infusion was the dominant early risk factor for mortality in these children with pulmonary hypertension, according to the researchers. Vasoactive infusion increased the absolute mortality risk by an average of 6.4% on day 2 of ICU admission.

These data “provide important new insight into the epidemiology and risk factors for mortality in children with pulmonary hypertension admitted to pediatric cardiac ICUs for critical medical indications. ... Prospective studies are required to establish a more nuanced view of these findings and identify management strategies that improve outcomes for this population,” the researchers wrote.