Noninvasive pulmonary arterial pressure monitoring in the children with severe pneumonia and respiratory failures and its significance

Objective To evaluate the value of noninvasive monitoring of pulmonary arterial pressure in the children with severe pneumonia and respiratory failure. Methods A prospective study was adopted to investigate 69 patients who suffered from severe pneumonia and respiratory failure in Pediatric Intensive Care Unit in Shanghai Children's Hospital from June 2013 to December 2013 were involved in this study, except for heart disease.The pulmonary arterial pressure (PAP) and cardiac function were monitored by using bedside color doppler ultrasound cardiogram, such as PAP, cardiac index (CI), left ventricle ejection fraction(LEFT), and heart early diastolic filling velocity maximum/heart late diastolic filling velocity maximum (E/A ratio). They were divided into 2 groups according to PAP, one group as pulmonary arterial pressure normal group, the other group as pulmonary arterial hypertension(PAH) group, and the impact of the PAP on the prognosis and mechanical ventilation was assessed.Milrinone[0.5 μg/(kg·min)]were given the patients who were combined with pulmonary hypertension, and the PAP and cardiac function before using Milrinone and 24 h, 48 h and 72 h after giving medicine was observed. Results Among 69 cases, 40 cases were male and 29 cases were female, age ranging from 2 months to 12 years old, and the weight range was (14.3±8.9) kg.The pe-diatric critical illness score(PICS) was 70.5±9.6, and the pediatric risk of score mortalityⅢ was 13.5±5.0.Among 69 cases, 46 cases had pulmonary arterial hypertension, 38 cases of them experienced mechanical ventilation, and 9 cases died.Among 23 cases who had no pulmonary arterial hypertension, only 8 cases experienced mechanical ventilation.There was a significant difference in the mechanical ventilation rate and mortality between two groups(χ2=15.78, P 0.05). However, 9 cases of them did not show any response to Milrinone, and in the end they couldn't live without mechanical ventilation, they died. Conclusions Noninvasive pulmonary arterial pressure monitoring could be beneficial in judging patient's condition and assessing prognosis of children with severe pneumonia and respiratory failure, and milrinone could decrease PAP. Key words: Pulmonary arterial hypertension; Color doppler ultrasound cardiogram; Pneumonia, severe; Respi-ratory failure; Milrinone; Child