Dados do Trabalho

Título

Pediatric Venous Excess Ultrasound Score (P-VExUS) for Non-Invasive Central Venous Pressure Estimation in Critically Ill Children

Objetivo

To establish a pediatric venous excess ultrasound score (P-VExUS) and evaluate its accuracy in identifying central venous pressure (CVP) values greater than 12 mmHg and less than 7 mmHg.

Métodos

In this prospective observational study, mechanically ventilated patients with CVP monitoring underwent ultrasonographic evaluation of the inferior vena cava, hepatic, portal, and renal veins. Each venous site was scored similarly to the VExUS score developed for adults. The accuracy of each venous site and the P-VExUS score was assessed using ROC curve analysis.

Resultados

A total of 53 children with a median age of 8 months [interquartile range 2 to 43] were included. To identify a CVP >12 mmHg, the P-VExUS demonstrated an area under the ROC curve (AUROC) of 0.94 (95% CI 0.84 to 0.99). The optimal cutoff score was 2 points (sensitivity of 80%, specificity of 91%, positive predictive value of 67%, and negative predictive value of 95%). For identifying CVP values <7 mmHg, the AUROC was 0.80 (95% CI 0.67 to 0.90). A multivariate stepwise logistic regression included scores from each venous site and the P-VExUS score. To identify CVP >12 mmHg, only the renal vein score was retained in the model, while for identifying CVP <7 mmHg, only the P-VExUS score was retained.

Conclusão

The P-VExUS score is a reliable tool for identifying pediatric patients with CVP values above 12 mmHg and below 7 mmHg.