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Karlsson J, Peters E, Denault A, Beaubien-Souligny W, Karsli C, Roter E. Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow. Acta Anaesthesiol Scand 2023; 67:1045-1053. [PMID: 37170621 DOI: 10.1111/aas.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/20/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND The primary aim of the current study was to investigate the ability of respiratory variations in descending aortic flow, measured with two-dimensional echo at the suprasternal notch (ΔVpeak dAo), to predict fluid responsiveness in anesthetized mechanically ventilated children. In addition, variations in peak descending aortic flow measured with apical transthoracic echo (ΔVpeak LVOT) were examined for the same properties. METHODS Twenty-seven patients under general anesthesia were investigated in this prospective observational study. Cardiac output, ΔVpeak dAo, and ΔVpeak LVOT were measured at stable conditions after anesthesia induction. The measurements were repeated after a 10 mL kg-1 fluid bolus. Patients were classified as responders if stroke volume index increased by >15% after fluid bolus. The ability of each parameter to predict fluid responsiveness was assessed using receiver operating characteristic curves. RESULTS Twenty-seven patients were analyzed, mean age and weight 43 months and 16 kg, respectively. Twelve responders and 15 non-responders were identified. ΔVpeak dAo was significantly higher in the responder group (14%, 95% confidence interval [CI]: 12%-17%) compared to the non-responder group (11%, 95% CI: 9%-13%) (p = .04) at baseline. Area under the ROC curve for ΔVpeak dAo and ΔVpeak LVOT was 0.73 (95% CI: 0.52-0.89, p = .02) and 0.56 (0.34-0.78, p = .3), respectively. A baseline level of ΔVpeak dAo of >14% predicted fluid responsiveness with a sensitivity of 58% (95% CI: 28%-85%) and specificity of 73% (95% CI: 45%-92%). CONCLUSION In mechanically ventilated children, ΔVpeak dAo identified fluid responders with moderate diagnostic power in the current study. ΔVpeak LVOT failed to predict fluid responders in the current study.
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Affiliation(s)
- Jacob Karlsson
- Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
- Department of Physiology and Pharmacology (FYFA), Karolinska Institute, Stockholm, Sweden
| | - Eric Peters
- Department of Anesthesia, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - André Denault
- Department of Anesthesia and Critical Care Division, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - William Beaubien-Souligny
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Cengiz Karsli
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan Roter
- Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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Sethasathien S, Jariyasakoolroj T, Silvilairat S, Srisurapanont M. Aortic Peak Flow Velocity As a Predictor of Fluid Responsiveness in Mechanically Ventilated Children: A Systematic Review and Meta-Analysis. Pediatr Crit Care Med 2023; 24:e352-e361. [PMID: 36856439 DOI: 10.1097/pcc.0000000000003219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVES This meta-analysis aimed to determine the accuracy of the respiratory variations in aortic peak flow velocity (delta Vpeak) in predicting fluid responsiveness and the moderators of that accuracy. DATA SOURCES We performed searches for studies that used delta Vpeak as a predictor of fluid responsiveness in mechanically ventilated children in PubMed, Embase, Scopus, and CINAHL from inception to June 20, 2022. STUDY SELECTION AND DATA EXTRACTION Fifteen studies ( n = 452) were included in this meta-analysis. The diagnostic test data of the included studies were synthesized as pooled sensitivity, specificity, and diagnostic odds ratio (DOR) and the area under the curve (AUC) of the summary receiver operating characteristic of delta Vpeak. DATA SYNTHESIS The delta Vpeak cutoff values applied in these studies had a median of 12.3% (interquartile range, 11.50-13.25%). The pooled sensitivity and specificity of delta Vpeak were 0.80 (95% CI, 0.71-0.87) and 0.82 (95% CI, 0.75-0.87), respectively. The DOR of delta Vpeak was 23.41 (95% CI, 11.61-47.20). The AUC of delta Vpeak was 0.87. Subgroup analyses revealed that the accuracy of delta Vpeak was not moderated by ventilator settings, measures of delta Vpeak, gold standard index, the cutoff gold standard value of responders, type and volume of fluid, duration of fluid challenge, use of vasoactive drugs, general anesthesia, and cardiopulmonary bypass. CONCLUSIONS By using the cutoff of approximately 12.3%, the delta Vpeak appears to have good accuracy in predicting fluid responsiveness in mechanically ventilated children. The moderators of delta Vpeak predictability are not found.
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Affiliation(s)
- Saviga Sethasathien
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Theerapon Jariyasakoolroj
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suchaya Silvilairat
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Carioca FDL, de Souza FM, de Souza TB, Rubio AJ, Brandão MB, Nogueira RJN, de Souza TH. Point-of-care ultrasonography to predict fluid responsiveness in children: A systematic review and meta-analysis. Paediatr Anaesth 2023; 33:24-37. [PMID: 36222022 DOI: 10.1111/pan.14574] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/29/2022] [Accepted: 10/09/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Point-of-care ultrasonography (POCUS) is proposed as a valuable method for hemodynamic monitoring and several ultrasound-based predictors of fluid responsiveness have been studied. The main objective of this study was to assess the accuracy of these predictors in children. METHODS PubMed, Embase, Scopus, ClinicalTrials.gov, and Cochrane Library databases were searched for relevant publications through July 2022. Pediatric studies reporting accuracy estimates of ultrasonographic predictors of fluid responsiveness were included since they had used a standard definition of fluid responsiveness and had performed an adequate fluid challenge. RESULTS Twenty-three studies involving 1028 fluid boluses were included, and 12 predictors were identified. A positive response to fluid infusion was observed in 59.7% of cases. The vast majority of participants were mechanically ventilated (93.4%). The respiratory variation in aortic blood flow peak velocity (∆Vpeak) was the most studied predictor, followed by the respiratory variation in inferior vena cava diameter (∆IVC). The pooled sensitivity and specificity of ∆Vpeak were 0.84 (95% CI, 0.76-0.90) and 0.82 (95% CI, 0.75-0.87), respectively, and the area under the summary receiver operating characteristic curve (AUSROC) was 0.89 (95% CI, 0.86-0.92). The ∆IVC presented a pooled sensitivity and specificity of 0.79 (95% CI, 0.62-0.90) and 0.70 (95% CI, 0.51-0.84), respectively, and an AUSROC of 0.81 (95% CI, 0.78-0.85). Significant heterogeneity in accuracy estimates across studies was observed. CONCLUSIONS POCUS has the potential to accurately predict fluid responsiveness in children. However, only ∆Vpeak was found to be a reliable predictor. There is a lack of evidence supporting the use of POCUS to guide fluid therapy in spontaneously breathing children.
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Affiliation(s)
- Fernando de Lima Carioca
- Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, Brazil
| | - Fabiana Mendes de Souza
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, Brazil
| | - Thalita Belato de Souza
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, Brazil
| | - Aline Junqueira Rubio
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, Brazil
| | - Marcelo Barciela Brandão
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, Brazil
| | - Roberto José Negrão Nogueira
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, Brazil
| | - Tiago Henrique de Souza
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, Brazil
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Loomba RS, Villarreal EG, Farias JS, Flores S, Bronicki RA. Fluid bolus administration in children, who responds and how? A systematic review and meta-analysis. Paediatr Anaesth 2022; 32:993-999. [PMID: 35736026 DOI: 10.1111/pan.14512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fluid boluses are frequently utilized in children. Despite their frequency of use, there is little objective data regarding the utility of fluid boluses, who they benefit the most, and what the effects are. AIMS This study aimed to conduct pooled analyses to identify those who may be more likely to respond to fluid boluses as well as characterize clinical changes associated with fluid boluses. METHODS A systematic review of the literature and meta-analysis was conducted to identify pediatric studies investigating the response to fluid boluses and clinical changes associated with fluid boluses. RESULTS A total of 15 studies with 637 patients were included in the final analyses with a mean age of 650 days ± 821.01 (95% CI 586 to 714) and a mean weight of 10.5 kg ± 7.19 (95% CI 9.94 to 11.1). The mean bolus volume was 12.14 ml/kg ± 4.09 (95% CI 11.8 to 12.5) given over a mean of 19.55 min ± 10.16 (95% CI 18.8 to 20.3). The following baseline characteristics were associated with increased likelihood of response [represented in mean difference (95% CI)]: greater age [207.2 days (140.8 to 273.2)], lower cardiac index [-0.5 ml/min/m2 (-0.9 to -0.3)], and lower stroke volume [-5.1 ml/m2 (-7.9 to -2.3)]. The following clinical parameters significantly changed after a fluid bolus: decreased HR [-5.6 bpm (-9.8 to -1.3)], increased systolic blood pressure [7.7 mmHg (1.0 to 14.4)], increased mean arterial blood pressure [5.5 mmHg (3.1 to 7.8)], increased cardiac index [0.3 ml/min/m2 (0.1 to 0.6)], increased stroke volume [4.3 ml/m2 (3.5 to 5.2)], increased central venous pressure [2.2 mmHg (1.1 to 3.3)], and increased systemic vascular resistance [2.1 woods units/m2 (0.1 to 4.2)]. CONCLUSION Fluid blouses increase arterial blood pressure or cardiac output by 10% in approximately 56% of pediatric patients. Fluid blouses lead to significant decrease in HR and significant increases in cardiac output, stroke volume, and systemic vascular resistance. Limited published data are available on the effects of fluid blouses on systemic oxygen delivery.
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Affiliation(s)
- Rohit S Loomba
- Cardiology, Advocate Children's Hospital, Chicago, Illinois, USA.,Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, Illinois, USA
| | - Enrique G Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico
| | - Juan S Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico
| | - Saul Flores
- Critical Care and Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Ronald A Bronicki
- Critical Care and Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
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Yenjabog P, Kanchongkittiphon W, Chutipongtanate S, Lertbunrian R, Ungprasert P. Dynamic parameters for fluid responsiveness in mechanically ventilated children: A systematic review. Front Pediatr 2022; 10:1010600. [PMID: 36353262 PMCID: PMC9638161 DOI: 10.3389/fped.2022.1010600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Fluid administration is the initial step of treatment of unstable pediatric patients. Evaluation of fluid responsiveness is crucial in mechanically ventilated children to avoid fluid overload, which increases mortality. We aim to review and compare the diagnostic performance of dynamically hemodynamic parameters for predicting fluid responsiveness in mechanically ventilated children. DESIGN A systematic review was performed using four electronic databases, including PubMed, EMBASE, Scopus, and Central, for published articles from 1 January 2010 to 31 December 2020. Studies were included if they described diagnostic performance of dynamic parameters after fluid challenge was performed in mechanically ventilated children. SETTINGS Pediatric intensive and cardiac intensive care unit, and operative room. PATIENTS Children aged 1 month to 18 years old who were under mechanical ventilation and required an intravenous fluid challenge. MEASUREMENTS AND MAIN RESULTS Twenty-seven studies were included in the systematic review, which included 1,005 participants and 1,138 fluid challenges. Respiratory variation in aortic peak velocity was reliable among dynamic parameters for predicting fluid responsiveness in mechanically ventilated children. All studies of respiratory variation in aortic peak velocity showed that the area under the receiver operating characteristic curve ranged from 0.71 to 1.00, and the cutoff value for determining fluid responsiveness ranged from 7% to 20%. Dynamic parameters based on arterial blood pressure (pulse pressure variation and stroke volume variation) were also used in children undergoing congenital heart surgery. The plethysmography variability index was used in children undergoing neurological and general surgery, including the pediatric intensive care patients. CONCLUSIONS The respiratory variation in aortic peak velocity exhibited a promising diagnostic performance across all populations in predicting fluid responsiveness in mechanically ventilated children. High sensitivity is advantageous in non-cardiac surgical patients and the pediatric intensive care unit because early fluid resuscitation improves survival in these patients. Furthermore, high specificity is beneficial in congenital heart surgery because fluid overload is particularly detrimental in this group of patients. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206400.
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Affiliation(s)
- Patcha Yenjabog
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wacharoot Kanchongkittiphon
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somchai Chutipongtanate
- Pediatric Translational Research Unit, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Clinical Epidemiology and Biostatistics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Rojjanee Lertbunrian
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, United States
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Song LL, Geng ZY, Ma W, Liu YF, Wang DX. Dynamic variables predict fluid responsiveness in pre-school and school children undergoing neurosurgery: a prospective observational study. Transl Pediatr 2021; 10:2972-2984. [PMID: 34976763 PMCID: PMC8649593 DOI: 10.21037/tp-21-281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The evidence that plethysmographic variability index (PVI), pulse pressure variation (PPV), FloTrac/Vigileo-derived stroke volume variation (SVV), and Eadyn (dynamic arterial elastance) predict fluid responsiveness in children is limited by conflicting results. We aim to evaluate their accuracy and reliability to predict fluid responsiveness after induction in children aged 4-9 years undergoing major neurosurgery. METHODS Children aged 4-9 years undergoing intracranial epileptic foci excision were enrolled. After the induction of anesthesia, fluid loading with 10 mL/kg of Ringer's solution over 10 min was administered before surgical incision. PVI, PPV, SVV, and Eadyn were measured before and within 5 min after fluid loading. Respiratory variation in aortic blood flow peak velocity (∆Vpeak) >15% at baseline, measured using transthoracic echocardiography, identified fluid "responders". The abilities of dynamic variables to predict an increase in mean arterial pressure (MAP) of >10% following fluid loading were also assessed. RESULTS Fourteen (31.8%) of forty-four patients were responders defined by a baseline ∆Vpeak >15%. Before fluid loading, only the PVI value was significantly different between R and NR (P=0.017). Baseline PVI showed fair diagnostic accuracy for fluid responsiveness, with an area under the curve (AUROC) of 0.735 and the cutoff value of 13%. The R group showed a significantly greater absolute change in PPV and SVV after fluid loading from baseline compared with the NR group (P=0.021 and 0.040, respectively). The absolute change in the PPV and SVV values from baseline was greater in R than those in NR (P=0.021 and 0.040, respectively). Twenty (45.5%) showed a MAP increase of >10% following fluid loading and were defined as responders. Baseline ∆Vpeak and SVV showed fair predictive values for a MAP increase of >10% (AUROC =0.758 and 0.715, respectively). CONCLUSIONS PVI at baseline showed fair reliability to predict fluid responsiveness after anesthesia induction in mechanically ventilated children aged 4-9 years undergoing neurosurgery. Baseline ∆Vpeak and SVV were fairly predictive for an increase in MAP following fluid loading.
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Affiliation(s)
- Lin-Lin Song
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Zhi-Yu Geng
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Wei Ma
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Ya-Fei Liu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
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Lee EP, Wu HP, Chan OW, Lin JJ, Hsia SH. Hemodynamic monitoring and management of pediatric septic shock. Biomed J 2021; 45:63-73. [PMID: 34653683 PMCID: PMC9133259 DOI: 10.1016/j.bj.2021.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/03/2021] [Accepted: 10/06/2021] [Indexed: 12/14/2022] Open
Abstract
Sepsis remains a major cause of morbidity and mortality among children worldwide. Furthermore, refractory septic shock and multiple organ dysfunction syndrome are the most critical groups which account for a high mortality rate in pediatric sepsis, and their clinical course often deteriorates rapidly. Resuscitation based on hemodynamics can provide objective values for identifying the severity of sepsis and monitoring the treatment response. Hemodynamics in sepsis can be divided into two groups: basic and advanced hemodynamic parameters. Previous therapeutic guidance of early-goal directed therapy (EGDT), which resuscitated based on the basic hemodynamics (central venous pressure and central venous oxygen saturation (ScvO2)) has lost its advantage compared with “usual care”. Optimization of advanced hemodynamics, such as cardiac output and systemic vascular resistance, has now been endorsed as better therapeutic guidance for sepsis. Despite this, there are still some important hemodynamics associated with prognosis. In this article, we summarize the common techniques for hemodynamic monitoring, list important hemodynamic parameters related to outcomes, and update evidence-based therapeutic recommendations for optimizing resuscitation in pediatric septic shock.
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Affiliation(s)
- En-Pei Lee
- Division of Pediatric Critical Care Medicine, and Pediatric Sepsis Study Group, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Guishan District, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Ping Wu
- Department of Pediatric Emergency Medicine, China Medical University Children Hospital, Taichung, Taiwan; Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Oi-Wa Chan
- Division of Pediatric Critical Care Medicine, and Pediatric Sepsis Study Group, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Guishan District, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, and Pediatric Sepsis Study Group, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Guishan District, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, and Pediatric Sepsis Study Group, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Guishan District, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Prediction of fluid responsiveness using lung recruitment manoeuvre in paediatric patients receiving lung-protective ventilation: A prospective observational study. Eur J Anaesthesiol 2021; 38:452-458. [PMID: 33186310 DOI: 10.1097/eja.0000000000001387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pressure-based dynamic variables are poor predictors of fluid responsiveness in children, and their predictability is expected to reduce further during lung-protective ventilation with a low tidal volume. OBJECTIVE We hypothesised that lung recruitment manoeuvre (LRM)-induced changes in dynamic variables improve their ability to predict fluid responsiveness in children. DESIGN Prospective observational study. SETTING Tertiary care children's hospital, single-centre study performed from June 2017 to May 2019. PATIENTS We included patients less than 7 years of age undergoing cardiac surgery. Neonates and patients with pulmonary hypertension, significant dysrhythmia, ventricular ejection fraction of less than 30% or pulmonary disease were excluded. INTERVENTION All patients were provided with lung-protective volume-controlled ventilation (tidal volume 6 ml kg-1, positive end-expiratory pressure 6 cmH2O). A LRM was applied with a continuous inspiratory pressure of 25 cmH2O for 20 s. MAIN OUTCOME MEASURE The ability of dynamic variables to predict fluid responsiveness was evaluated by the area under the receiver operating characteristic curve [area under the curve (AUC)]. Fluid responsiveness was defined as an increase in the cardiac index by more than 15% with crystalloid administration (10 ml kg-1). RESULTS Thirty patients were included in the final analysis, of whom 19 were responders. The baseline pleth variability index (PVI) (AUC 0.794, 95% confidence interval 0.608 to 0.919, P < 0.001) and LRM-induced PVI (AUC 0.711, 95% confidence interval 0.517 to 0.861, P = 0.026) could predict fluid responsiveness. The respiratory variation of pulse oximetry photoplethysmographic waveform and pulse pressure variation did not predict fluid responsiveness regardless of the LRM. CONCLUSION The PVI is effective in predicting fluid responsiveness in paediatric patients with lung-protective ventilation regardless of a LRM. However, the LRM did not improve the ability of the other dynamic variables to predict fluid responsiveness in these patients. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifier: NCT03184961.
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Zhang Q, Shi XR, Shan Y, Wan J, Ju X, Song X, Fan C, Lu X, Sun J, Duan L, Lin Z, Liu J. Respiratory Variations in Peak Peripheral Artery Velocities and Waveforms for Rapid Assessment of Fluid Responsiveness in Traumatic Shock Patients. Med Sci Monit 2021; 27:e928804. [PMID: 33414360 PMCID: PMC7802376 DOI: 10.12659/msm.928804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to assess the correlation between the variability of the end-inspiratory and end-expiratory blood flow waveform and fluid responsiveness (FR) in traumatic shock patients who underwent mechanical ventilation by evaluating peripheral arterial blood flow parameters. Material/Methods A cohort of 60 patients with traumatic shock requiring mechanical ventilation-controlled breathing received ultrasound examinations to assess the velocity of carotid artery (CA), femoral artery (FA) and brachial artery (BA). A rehydration test was performed in which of 250 mL of 0.9% saline was administered within 30 min between the first and second measurement of cardiac output by echocardiography. Then, all patients were divided into 2 groups, a responsive group (FR+) and a non-responsive group (FR−). The velocity of end-inspiratory and end-expiratory peripheral arterial blood flow of all patients was ultrasonically measured, and the variability were measured between end-inspiratory and end-expiratory. Results The changes in the end-inspiratory and end-expiratory carotid artery blood flow velocity waveforms of the FR+ groups were significantly different from those of the FR− group (P<0.001). A statistically significant difference in ΔVmax (CA), ΔVmax (BA), and ΔVmax (FA) between these 2 groups was found (all P<0.001). The ROC curve showed that ΔVmax (CA) and ΔVmax (BA) were more sensitive values to predict FR compared to ΔVmax (FA). The sensitivity of ΔVmax (CA), ΔVmax (FA), and ΔVmax (BA) was 70.0%, 86.7%, and 93.3%, respectively. Conclusions The study showed that periodic velocity waveform changes in the end-inspiratory and end-expiratory peripheral arterial blood flow can be used for quick assessment of fluid responsiveness.
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Affiliation(s)
- Qian Zhang
- Department of Emergency and Critical Care Medicine, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Xiu-Rong Shi
- Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Yi Shan
- Department of Emergency and Intensive Care Unit (ICU), Changzheng Hospital Affiliated to Second Military Medical University, Shanghai, China (mainland)
| | - Jian Wan
- Department of Emergency and Critical Care Medicine, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Xuan Ju
- Department of Emergency and Critical Care Medicine, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Xi Song
- Emergency and Critical Care Medicine, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Conghui Fan
- Emergency and Critical Care Medicine, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Xinyuan Lu
- Emergency and Critical Care Medicine, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Jie Sun
- Emergency and Critical Care Medicine, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Liwei Duan
- Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Zhaofen Lin
- Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Jinlong Liu
- Department of Biotechnology and Pathology, Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
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Role of TFA-1 adhesive forehead sensors in predicting fluid responsiveness in anaesthetised children: A prospective cohort study. Eur J Anaesthesiol 2020; 37:713-718. [PMID: 32412989 DOI: 10.1097/eja.0000000000001235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The TFA-1 adhesive forehead sensor is a newly developed pulse oximeter for the measurement of the plethysmographic variability index (PVI) at the forehead, and for the rapid detection of changes in oxygen saturation during low perfusion. OBJECTIVES We evaluated the ability of the TFA-1 sensor to predict fluid responsiveness in children under general anaesthesia. DESIGN Prospective cohort study. SETTING Single tertiary care children's hospital. PATIENTS Thirty-seven children aged 1 to 5 years under general anaesthesia and requiring invasive arterial pressure monitoring. MAIN OUTCOME MEASURES The baseline PVI of TFA-1 and finger sensors, respiratory variation of aorta blood flow peak velocity (ΔVpeak) and stroke volume index (SVI) obtained using transthoracic echocardiography were assessed. After fluid loading of 10 ml kg crystalloids over 10 min, SVI was reassessed. Responders were defined as those with an increase in SVI greater than 15% from the baseline. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive ability of the PVI of TFA-1 and finger sensors and ΔVpeak for fluid responsiveness. RESULTS Seventeen (56.6%) patients responded to volume expansion. Before fluid loading, the PVI of TFA-1 and finger sensors and ΔVpeak (mean ± SD) of the responders were 11.2 ± 4.4, 11.4 ± 5.1 and 14.8 ± 3.9%, respectively, and those of the nonresponders were 7.4 ± 3.9, 8.1 ± 3.6 and 11.0 ± 3.3%, respectively. ROC curve analysis indicated that the PVI of TFA-1 and finger sensors and ΔVpeak could predict fluid responsiveness. The areas under the curve were 0.8 [P = 0.00; 95% confidence interval (CI) 0.60 to 0.91], 0.7 (P = 0.02; 95% CI 0.53 to 0.87) and 0.8 (P = 0.00; 95% CI 0.59 to 0.91), respectively. The cut-off values for the PVI of TFA-1 and finger sensors and ΔVpeak were 6.0, 9.0 and 10.6%, respectively. CONCLUSION The PVI of TFA-1 forehead sensor is a good alternative, but is not superior to the finger sensor and ΔVpeak in evaluating fluid responsiveness in mechanically ventilated children under general anaesthesia. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT03132480.
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Niyogi SG, Sen IM, Jayant A, Mandal B, Bhardwaj N, Yaddanapudi S, Mathew P. Surrogate indices of aortic peak systolic velocity variation to monitor fluid responsiveness in pediatric non-cardiac surgery: a prospective observational study. J Clin Monit Comput 2019; 34:1159-1166. [PMID: 31811550 DOI: 10.1007/s10877-019-00431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
Aortic peak systolic velocity variation (ΔVpeakAo) is a reliable dynamic indicator of preload in mechanically ventilated children. However, easily measurable alternative parameters like carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakSs) are not well evaluated in children. The aim of the study was to find correlation between ΔVpeakCa and ΔVpeakSs to ΔVpeakAo, as potential surrogate markers of fluid responsiveness. 52 children, 1-12 years old, undergoing major non-cardiac surgeries under general endotracheal anaesthesia were recruited for this single-centre prospective observational study. ΔVpeakAo, ΔVpeakCa and ΔVpeakSs were measured by pulsed wave Doppler in appropriate windows, measuring maximum and minimum peak flow velocity over a single respiratory cycle. Calculated parameters were compared by a repeated measures study design. Correlation coefficients were 0.82 between ΔVpeakAo and ΔVpeakSs and 0.73 between ΔVpeakAo and ΔVpeakCa. Bland-Altman analysis showed minimal bias of 1.86 percentage points with limits of agreement of 11.21 to - 7.49 (ΔVpeakAo and ΔVpeakSs) and 3.93 percentage points with limits of agreement of 14.04 to - 6.18 (ΔVpeakAo and ΔVpeakCa). ΔVpeakSs and ΔVpeakCa also showed good discrimination to predict ΔVpeakAo (lying in previously validated fluid responsive zones) with sensitivities and specificities of 82.25% and 85% with cut-off of 11% for ΔVpeakSs, and 88.52% and 70% with cut-off of 8.6% for ΔVpeakCa. Carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakCa) can be potential surrogate markers for Aortic peak systolic velocity variation (ΔVpeakAo) in assessing fluid responsiveness in mechanically ventilated children.Study registration: Clinicaltrials.gov ID NCT03155555.
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Affiliation(s)
- Subhrashis Guha Niyogi
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
| | - Indu Mohini Sen
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India.
| | - Aveek Jayant
- Department of Anaesthesiology and Critical Care Medicine, Amrita Institute of Medical Sciences and Research Centre, Peeliyadu Road, Ponekkara, Edappally, Kochi, Kerala, 682041, India
| | - Banashree Mandal
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
| | - Preethy Mathew
- Department of Anaesthesia and Intensive Care, PGIMER Chandigarh, Sector 12, Chandigarh, 160011, India
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Wang X, Jiang L, Liu S, Ge Y, Gao J. Value of respiratory variation of aortic peak velocity in predicting children receiving mechanical ventilation: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:372. [PMID: 31757222 PMCID: PMC6874822 DOI: 10.1186/s13054-019-2647-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022]
Abstract
Background Accurate volume assessment is crucial in children under fluid therapy. Over the last decade, respiratory variation of aortic peak velocity (△VPeak) has been applied in intensive care unit and surgeries to help clinicians guide fluid management. The aim of this systematic review and meta-analysis was to test diagnostic performance of △VPeak in predicting fluid responsiveness of ventilated children and to explore the potential factors that influence the accuracy of △VPeak. Methods We searched PubMed, Embase, and Cochrane from inception to April 2019 that evaluated association between △VPeak and fluid responsiveness after fluid challenge in children receiving mechanical ventilation. Data synthesis was performed within the bivariate mixed-effects regression model modified for synthesis of diagnostic test data. Results Eleven studies with a total of 302 pediatric patients were included in our meta-analysis. The pooled sensitivity and specificity of △VPeak was 0.89 (95%CI = 0.77 to 0.95) and 0.85 (95%CI = 0.77 to 0.91), respectively. The diagnostic odds ratio (DOR) of △VPeak was 48 (95%CI = 15 to 155). SROC yielded an area under the curve of 0.91 (95%CI = 0.88–0.93). The △VPeak cutoff value was nearly conically symmetrical distribution and varied from 7 to 20%. After excluding several extreme studies, most data were centered between 12 and 13%. The medium and mean cutoff values of △VPeak were 12.2% and 12.7%, respectively. In subgroup analysis, compared to total data analysis, △VPeak performed weaker in the younger children group (mean ages < 25 months), with lower area under the summary receiver operating characteristic curve (AUSROC) of 0.80 (0.76 to 0.83), but stronger in the older children group (mean ages > 25 months), with AUSROC of 0.96 (0.94 to 0.97). Conclusions Overall, △VPeak has a good ability in predicting fluid responsiveness of children receiving mechanical ventilation, but this ability decreases in younger children (mean age < 25 months). The optimal threshold of △VPeak to predict fluid responsiveness in ventilated children is reliable between 12 and 13%. Trial registration The study protocol was registered prospectively on PROSPERO no. CRD42019129361.
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Affiliation(s)
- Xiaoying Wang
- Department of Anesthesiology, Clinical Medical College of Yangzhou University (Northern Jiangsu People's Hospital), Yangzhou, 225001, China.
| | - Lulu Jiang
- Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Shuai Liu
- Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yali Ge
- Department of Anesthesiology, Clinical Medical College of Yangzhou University (Northern Jiangsu People's Hospital), Yangzhou, 225001, China
| | - Ju Gao
- Department of Anesthesiology, Clinical Medical College of Yangzhou University (Northern Jiangsu People's Hospital), Yangzhou, 225001, China.
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Lee JH, Kim EH, Jang YE, Kim HS, Kim JT. Fluid responsiveness in the pediatric population. Korean J Anesthesiol 2019; 72:429-440. [PMID: 31591858 PMCID: PMC6781210 DOI: 10.4097/kja.19305] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/01/2019] [Indexed: 01/23/2023] Open
Abstract
It is challenging to predict fluid responsiveness, that is, whether the cardiac index or stroke volume index would be increased by fluid administration, in the pediatric population. Previous studies on fluid responsiveness have assessed several variables derived from pressure wave measurements, plethysmography (pulse oximeter plethysmograph amplitude variation), ultrasonography, bioreactance data, and various combined methods. However, only the respiratory variation of aortic blood flow peak velocity has consistently shown a predictive ability in pediatric patients. For the prediction of fluid responsiveness in children, flow- or volume-dependent, noninvasive variables are more promising than pressure-dependent, invasive variables. This article reviews various potential variables for the prediction of fluid responsiveness in the pediatric population. Differences in anatomic and physiologic characteristics between the pediatric and adult populations are covered. In addition, some important considerations are discussed for future studies on fluid responsiveness in the pediatric population.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Xu LY, Tu GW, Cang J, Hou JY, Yu Y, Luo Z, Guo KF. End-expiratory occlusion test predicts fluid responsiveness in cardiac surgical patients in the operating theatre. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:315. [PMID: 31475185 PMCID: PMC6694235 DOI: 10.21037/atm.2019.06.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether a 20-second end-expiratory occlusion (EEO) test can predict fluid responsiveness in cardiac surgery patients in the operating theatre. METHODS This prospective study enrolled 75 mechanically ventilated patients undergoing elective coronary artery bypass grafting surgery. Hemodynamic data coupled with transesophageal echocardiography monitoring of the velocity time integral (VTI) and the peak velocity (Vmax) at the left ventricular outflow tract were collected at each step (baseline 1, EEO, baseline 2 and fluid challenge). Patients were divided into fluid responders (increase in VTI ≥15%) and non-responders (increase in VTI <15%) after a fluid challenge (6 mL 0.9% saline per kg, given in 10 minutes). RESULTS Fluid challenge significantly increased the VTI by more than 15% in 36 (48%) patients (responders). An increase in VTI greater than 5% during the EEO test predicted fluid responsiveness with a sensitivity of 81% and a specificity of 93%. The area under the receiver-operating characteristic curve (AUROC) of ΔVTI-EEO was 0.90 [95% confidence interval (CI): 0.83-0.97]. ΔVmax-EEO was poorly predictive of fluid responsiveness, with an AUC of 0.75 (95% CI: 0.63-0.86). CONCLUSIONS Changes in VTI induced by a 20-second EEO can reliably predict fluid responsiveness in cardiac surgical patients in the operating theatre, whereas the changes in Vmax cannot.
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Affiliation(s)
- Li-Ying Xu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Guo-Wei Tu
- Department of Crit Care Med, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Cang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jun-Yi Hou
- Department of Crit Care Med, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ying Yu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhe Luo
- Department of Crit Care Med, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Crit Care Med, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Ke-Fang Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Saugel B, Flick M, Bendjelid K, Critchley LAH, Vistisen ST, Scheeren TWL. Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management. J Clin Monit Comput 2019; 33:211-222. [PMID: 30847738 PMCID: PMC6420447 DOI: 10.1007/s10877-019-00297-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 12/05/2022]
Abstract
Hemodynamic management is a mainstay of patient care in the operating room and intensive care unit (ICU). In order to optimize patient treatment, researchers investigate monitoring technologies, cardiovascular (patho-) physiology, and hemodynamic treatment strategies. The Journal of Clinical Monitoring and Computing (JCMC) is a well-established and recognized platform for publishing research in this field. In this review, we highlight recent advancements and summarize selected papers published in the JCMC in 2018 related to hemodynamic monitoring and management.
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Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg- Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Moritz Flick
- Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg- Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karim Bendjelid
- Department of Anesthesiology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Lester A H Critchley
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shantin, N.T., Hong Kong.,The Belford Hospital, Fort William, The Highlands, Scotland, UK
| | - Simon T Vistisen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Morparia K, Berg J, Basu S. Confidence level of pediatric trainees in management of shock states. World J Crit Care Med 2018; 7:31-38. [PMID: 29736378 PMCID: PMC5934529 DOI: 10.5492/wjccm.v7.i2.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/12/2018] [Accepted: 04/22/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess overall confidence level of trainees in assessing and treating shock, we sought to improve awareness of recurrent biases in clinical decision-making to help address appropriate educational interventions.
METHODS Pediatric trainees on a national listserv were offered the opportunity to complete an electronic survey anonymously. Four commonly occurring clinical scenarios were presented, and respondents were asked to choose whether or not they would give fluid, rank factors utilized in decision-making, and comment on confidence level in their decision.
RESULTS Pediatric trainees have a very low confidence level for assessment and treatment of shock. Highest confidence level is for initial assessment and treatment of shock involving American College of Critical Care Medicine/Pediatric Advanced Life Support recommendations. Children with preexisting cardiac comorbidities are at high risk of under-resuscitation.
CONCLUSION Pediatric trainees nationwide have low confidence in managing various shock states, and would benefit from guidance and teaching around certain common clinical situations.
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Affiliation(s)
- Kavita Morparia
- Department of Pediatric Critical Care, Children’s Hospital of New Jersey, Newark Beth Israel Medical Center, Newark, NJ 07112, United States
| | - Julie Berg
- Department of Emergency Medicine, Children’s National Health System, Washington, DC 20010, United States
| | - Sonali Basu
- Department of Critical Care Medicine, George Washington University, Children’s National Health System, Washington, DC 20010, United States
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Suprasternal notch echocardiography: a potential alternative for the measurement of respiratory variation in aortic blood flow peak velocity in mechanically ventilated children. J Clin Monit Comput 2017. [DOI: 10.1007/s10877-017-0039-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bendjelid K. Fact and controversies when assessing fluid responsiveness. J Clin Monit Comput 2017; 32:213-214. [PMID: 28424933 DOI: 10.1007/s10877-017-0018-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Karim Bendjelid
- Intensive Care Service, Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.
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