J Pediatr Intensive Care 2017; 06(03): 145-151
DOI: 10.1055/s-0036-1593388
Original Article
Georg Thieme Verlag KG Stuttgart · New York

A Survey of Pediatric Critical Care Providers on the Presence, Severity, and Assessment of Capillary Leak in Critically Ill Children

Richard Pierce
1   Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States
Peter M. Luckett
2   Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States
Edward Vincent S. Faustino
1   Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States
› Author Affiliations
Further Information

Publication History

04 July 2016

11 August 2016

Publication Date:
26 September 2016 (online)


Purpose To determine provider opinions on factors most commonly used to assess the presence and severity of pathologic capillary leak in critically ill children.

Methods We conducted an electronic survey of pediatric critical care providers. Patient scenarios were presented to assess opinions on the risk, presence, and clinical significance of capillary leak. Responses were obtained using Likert scales and multiple-choice questions.

Results A total of 160 responses were analyzed. Respondents agreed that capillary leak is present in the scenario with septic shock while respondents somewhat agreed that it is also present with poly-trauma, cardiac arrest, or cardiopulmonary bypass. They agreed that physical exam, but neither agreed nor disagreed that laboratory tests, can be used to assess and follow the severity of capillary leak in these children. Generalized edema, increase in weight, and pulmonary crackles were commonly identified parameters for assessing capillary leak. The patient factor most commonly identified with capillary leak was presence of infection, while treatment factors most commonly identified were cardiopulmonary bypass and general anesthesia.

Conclusion There is agreement that capillary leak is common in critically ill children and exacerbates disease. The parameters identified in this study may facilitate a more standardized clinical evaluation of pathologic capillary leak for future studies.

  • References

  • 1 Pober JS, Sessa WC. Inflammation and the blood microvascular system. Cold Spring Harb Perspect Biol 2015; 7 (01) a016345
  • 2 Wetzel RC. The intensivist's system. Crit Care Med 1993; 21 (9, Suppl): S341-S344
  • 3 Deanfield JE, Halcox JP, Rabelink TJ. Endothelial function and dysfunction: testing and clinical relevance. Circulation 2007; 115 (10) 1285-1295
  • 4 Fishel RS, Are C, Barbul A. Vessel injury and capillary leak. Crit Care Med 2003; 31 (8, Suppl): S502-S511
  • 5 Mehta D, Malik AB. Signaling mechanisms regulating endothelial permeability. Physiol Rev 2006; 86 (01) 279-367
  • 6 Aird WC. Phenotypic heterogeneity of the endothelium: I. Structure, function, and mechanisms. Circ Res 2007; 100 (02) 158-173
  • 7 Mano G, Gilmore V, Leventhal M. On the mechanism of vascular leakage caused by histamine type mediators. A microscopic study in vivo. Circa Res 1967; 21 (06) 833-847
  • 8 McDonald DM, Thurston G, Baluk P. Endothelial gaps as sites for plasma leakage in inflammation. Microcirculation 1999; 6 (01) 7-22
  • 9 Pober JS, Sessa WC. Evolving functions of endothelial cells in inflammation. Nat Rev Immunol 2007; 7 (10) 803-815
  • 10 Aird WC. The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood 2003; 101 (10) 3765-3777
  • 11 Cordemans C, De Laet I, Van Regenmortel N. , et al. Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Ann Intensive Care 2012; ;2(Suppl 1): S1
  • 12 Katzenelson R, Perel A, Berkenstadt H. , et al. Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water. Crit Care Med 2004; 32 (07) 1550-1554
  • 13 Margarson MP, Soni NC. Plasma volume measurement in septic patients using an albumin dilution technique: comparison with the standard radio-labelled albumin method. Intensive Care Med 2005; 31 (02) 289-295
  • 14 Morisawa K, Fujitani S, Taira Y. , et al; PiCCO Pulmonary Edema Study Group. Difference in pulmonary permeability between indirect and direct acute respiratory distress syndrome assessed by the transpulmonary thermodilution technique: a prospective, observational, multi-institutional study. J Intensive Care 2014; 2 (01) 24
  • 15 Esposito C, Gerlach H, Brett J, Stern D, Vlassara H. Endothelial receptor-mediated binding of glucose-modified albumin is associated with increased monolayer permeability and modulation of cell surface coagulant properties. J Exp Med 1989; 170 (04) 1387-1407
  • 16 Demircan M, Gurunluoglu K, Karaman A, Mizrak B. Damaging Effects of Total Parenteral Nutrition Formula on Vascular Endothelium. J Pediatr Gastroenterol Nutr 2015; 61 (04) 464-468
  • 17 Harvey KA, Xu Z, Pavlina TM, Zaloga GP, Siddiqui RA. Modulation of endothelial cell integrity and inflammatory activation by commercial lipid emulsions. Lipids Health Dis 2015; 14: 9
  • 18 Petri M, Orbai AM, Alarcón GS. , et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64 (08) 2677-2686
  • 19 Fries JF. Methodology of validation of criteria for SLE. Scand J Rheumatol Suppl 1987; 65: 25-30
  • 20 Morrison W, Womer J, Nathanson P. , et al. Pediatricians' Experience with Clinical Ethics Consultation: A National Survey. J Pediatr 2015; 167 (04) 919-924.e1
  • 21 Alfares FA, Jones MB, Ramakrishnan K, Endicott KM, Zurakowski D, Shankar V, Nath DS. Perceptions of Bedside Cardiac Critical Care Registered Nurses on 24 Hour Attending Intensivist Coverage. Congenit Heart Dis 2016; 11 (04) 354-358
  • 22 Radabaugh CL, Ruch-Ross HS, Riley CL. , et al. Practice Patterns in Pediatric Critical Care Medicine: Results of a Workforce Survey. Pediatr Crit Care Med 2015; 16 (08) e308-e312