1
|
Sharma KP. Temporary hypoxemia at high altitude in an intensive care unit physician. SAGE Open Med Case Rep 2023; 11:2050313X231153526. [PMID: 36776206 PMCID: PMC9909067 DOI: 10.1177/2050313x231153526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023] Open
Abstract
A 42-year-old pediatric intensive care unit physician traveled to Nepal and took a helicopter trip to Everest Base Camp. The helicopter reached an altitude of 5500 m during flight and descended at different destinations with varying altitudes. At Hotel Everest View at 3820 m, his oxygen saturation was 79%. He had mild tachypnea and deep breathing but was able to walk around, jump, and take photographs. He returned to Kathmandu (altitude, 1324 m) without using any supplemental oxygen during the entire trip. Based on calculations with the alveolar gas equation, he observed that he and his fellow passengers probably had hypoxemia during the trip. In summary, temporary hypoxemia associated with high altitude in healthy individuals without cardiorespiratory compromise may not require oxygen therapy. In contrast, intensive care unit patients who have respiratory failure may have similar oxygen saturation levels but may require oxygen therapy and mechanical ventilation. The oxygen saturation level must be interpreted in consideration of the clinical scenario before deciding about the need for oxygen therapy.
Collapse
Affiliation(s)
- Kamal P Sharma
- Kamal P Sharma, Children & Women’s Hospital, University of South Alabama College of Medicine, 1700 Center Street, Mobile, AL 36604, USA.
| |
Collapse
|
2
|
Ashby DW, Balakrishnan B, Gourlay DM, Meyer MT, Nimmer M, Drendel AL. Utilizing Near-Infrared Spectroscopy to Identify Pediatric Trauma Patients Needing Lifesaving Interventions: A Prospective Study. Pediatr Emerg Care 2023; 39:13-19. [PMID: 35580188 DOI: 10.1097/pec.0000000000002710] [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: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to prospectively investigate the role of near-infrared spectroscopy (NIRS) in identifying pediatric trauma patients who required lifesaving interventions (LSIs). METHODS Prospective cohort study of children age 0 to 18 years who activated the trauma team response between August 15, 2017, and February 12, 2019, at a large, urban pediatric emergency department (ED).The relationship between the lowest somatic NIRS saturation and the need for LSIs (based on published consensus definition) was investigated. Categorical variables were analyzed by χ 2 test, and continuous variables were analyzed by Student t test. RESULTS A total of 148 pediatric trauma patients had somatic NIRS monitoring and met the inclusion criteria. Overall, 65.5% were male with a mean ± SD age of 10.9 ± 6.0 years. Injuries included 67.6% blunt trauma and 28.4% penetrating trauma with mortality of 3.4% (n = 5). Overall, the median lowest somatic NIRS value was 72% (interquartile range, 58%-88%; range, 15%-95%), and 43.9% of patients had a somatic NIRS value <70%. The median somatic NIRS duration recorded was 11 minutes (interquartile range, 7-17 minutes; range, 1-105 minutes). Overall, 36.5% of patients required a LSI including 53 who required a lifesaving procedure, 17 required blood products, and 17 required vasopressors. Among procedures, requiring a thoracostomy was significant.Pediatric trauma patients with a somatic NIRS value <70% had a significantly increased odds of requiring a LSI (odds ratio, 2.11; 95% confidence interval, 1.07-4.20). Somatic NIRS values <70% had a sensitivity and specificity of 56% and 63%, respectively. CONCLUSIONS Pediatric trauma patients with somatic NIRS values <70% within 30 minutes of ED arrival have an increased odds of requiring LSIs. Among LSIs, pediatric trauma patients requiring thoracostomy was significant. The role of NIRS in incrementally improving the identification of critically injured children in the ED and prehospital setting should be evaluated in larger prospective multicenter studies.
Collapse
Affiliation(s)
- David W Ashby
- From the Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | - David M Gourlay
- Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Michael T Meyer
- Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Mark Nimmer
- Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Amy L Drendel
- Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
3
|
Gomez LA, Shen Q, Doyle K, Vrosgou A, Velazquez A, Megjhani M, Ghoshal S, Roh D, Agarwal S, Park S, Claassen J, Kleinberg S. Classification of Level of Consciousness in a Neurological ICU Using Physiological Data. Neurocrit Care 2023; 38:118-128. [PMID: 36109448 PMCID: PMC9935697 DOI: 10.1007/s12028-022-01586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/08/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Impaired consciousness is common in intensive care unit (ICU) patients, and an individual's degree of consciousness is crucial to determining their care and prognosis. However, there are no methods that continuously monitor consciousness and alert clinicians to changes. We investigated the use of physiological signals collected in the ICU to classify levels of consciousness in critically ill patients. METHODS We studied 61 patients with subarachnoid hemorrhage (SAH) and 178 patients with intracerebral hemorrhage (ICH) from the neurological ICU at Columbia University Medical Center in a retrospective observational study of prospectively collected data. The level of consciousness was determined on the basis of neurological examination and mapped to comatose, vegetative state or unresponsive wakefulness syndrome (VS/UWS), minimally conscious minus state (MCS-), and command following. For each physiological signal, we extracted time-series features and performed classification using extreme gradient boosting on multiple clinically relevant tasks across subsets of physiological signals. We applied this approach independently on both SAH and ICH patient groups for three sets of variables: (1) a minimal set common to most hospital patients (e.g., heart rate), (2) variables available in most ICUs (e.g., body temperature), and (3) an extended set recorded mainly in neurological ICUs (absent for the ICH patient group; e.g., brain temperature). RESULTS On the commonly performed classification task of VS/UWS versus MCS-, we achieved an area under the receiver operating characteristic curve (AUROC) in the SAH patient group of 0.72 (sensitivity 82%, specificity 57%; 95% confidence interval [CI] 0.63-0.81) using the extended set, 0.69 (sensitivity 83%, specificity 51%; 95% CI 0.59-0.78) on the variable set available in most ICUs, and 0.69 (sensitivity 56%, specificity 78%; 95% CI 0.60-0.78) on the minimal set. In the ICH patient group, AUROC was 0.64 (sensitivity 56%, specificity 65%; 95% CI 0.55-0.74) using the minimal set and 0.61 (sensitivity 50%, specificity 80%; 95% CI 0.51-0.71) using the variables available in most ICUs. CONCLUSIONS We find that physiological signals can be used to classify states of consciousness for patients in the ICU. Building on this with intraday assessments and increasing sensitivity and specificity may enable alarm systems that alert physicians to changes in consciousness and frequent monitoring of consciousness throughout the day, both of which may improve patient care and outcomes.
Collapse
Affiliation(s)
- Louis A Gomez
- Stevens Institute of Technology, 1 Castle Point on Hudson, Hoboken, NJ, 07030, USA
| | - Qi Shen
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Kevin Doyle
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Athina Vrosgou
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Angela Velazquez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Murad Megjhani
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Shivani Ghoshal
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - David Roh
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Sachin Agarwal
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Soojin Park
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Samantha Kleinberg
- Stevens Institute of Technology, 1 Castle Point on Hudson, Hoboken, NJ, 07030, USA.
| |
Collapse
|
4
|
Iddawela S, Naseem S, Stickley J, Botha P, Khan NE, Barron DJ, Jones TJ, Drury NE. Non-invasive cardiac output monitoring with electrical velocimetry after cardiac surgery in infants. Ann R Coll Surg Engl 2022; 104:583-587. [PMID: 35089823 PMCID: PMC9433180 DOI: 10.1308/rcsann.2021.0258] [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] [Accepted: 05/04/2021] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION Low cardiac output following cardiac surgery is a major determinant of outcome that may be improved by early detection, yet there are no widely accepted methods for its measurement in young children. We evaluated the feasibility of the routine use of electrical velocimetry, a non-invasive technique providing continuous measurement of cardiac output, in infants in the early postoperative period. METHODS With ethical approval and parental consent, infants undergoing cardiac surgery were recruited. The ICON electrical velocimetry monitor was attached on admission to the intensive care unit (ICU) and remained for up to 24h. RESULTS A total of 15 infants were recruited, median age 3 months (interquartile range (IQR) 0.5-7.5) and weight 4.8kg (IQR 3.9-7.1), undergoing various operations. Cardiac index had a weak correlation with arterial lactate (r=-0.24, p=0.02) and no correlation with blood pressure, central venous pressure or arteriovenous oxygen difference. Data were recorded for a median of 19h (range 5-24), with lead detachment or movement artefact the most common causes of data loss. There was marked minute-to-minute variability, with 25% of consecutive measurements having >5% variability. CONCLUSION Cardiac index measured by electrical velocimetry in infants in the early postoperative period is impaired by frequent data loss and marked intrapatient variability. Our feasibility study suggests that it is unsuitable for use as a routine monitoring tool in the setting of postsurgical ICU care.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - NE Drury
- CORRESPONDENCE TONigel Drury, E:
| |
Collapse
|
5
|
Crapnell RD, Dempsey NC, Sigley E, Tridente A, Banks CE. Electroanalytical point-of-care detection of gold standard and emerging cardiac biomarkers for stratification and monitoring in intensive care medicine - a review. Mikrochim Acta 2022; 189:142. [PMID: 35279780 PMCID: PMC8917829 DOI: 10.1007/s00604-022-05186-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/17/2022] [Indexed: 12/27/2022]
Abstract
Determination of specific cardiac biomarkers (CBs) during the diagnosis and management of adverse cardiovascular events such as acute myocardial infarction (AMI) has become commonplace in emergency department (ED), cardiology and many other ward settings. Cardiac troponins (cTnT and cTnI) and natriuretic peptides (BNP and NT-pro-BNP) are the preferred biomarkers in clinical practice for the diagnostic workup of AMI, acute coronary syndrome (ACS) and other types of myocardial ischaemia and heart failure (HF), while the roles and possible clinical applications of several other potential biomarkers continue to be evaluated and are the subject of several comprehensive reviews. The requirement for rapid, repeated testing of a small number of CBs in ED and cardiology patients has led to the development of point-of-care (PoC) technology to circumvent the need for remote and lengthy testing procedures in the hospital pathology laboratories. Electroanalytical sensing platforms have the potential to meet these requirements. This review aims firstly to reflect on the potential benefits of rapid CB testing in critically ill patients, a very distinct cohort of patients with deranged baseline levels of CBs. We summarise their source and clinical relevance and are the first to report the required analytical ranges for such technology to be of value in this patient cohort. Secondly, we review the current electrochemical approaches, including its sub-variants such as photoelectrochemical and electrochemiluminescence, for the determination of important CBs highlighting the various strategies used, namely the use of micro- and nanomaterials, to maximise the sensitivities and selectivities of such approaches. Finally, we consider the challenges that must be overcome to allow for the commercialisation of this technology and transition into intensive care medicine.
Collapse
Affiliation(s)
- Robert D Crapnell
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Nina C Dempsey
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.
| | - Evelyn Sigley
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Ascanio Tridente
- Intensive Care Unit, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, Prescot, L35 5DR, UK
| | - Craig E Banks
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.
| |
Collapse
|
6
|
Ashby DW, Gourlay DM, Balakrishnan B, Meyer MT, Drendel AL. Utilizing Near-Infrared Spectroscopy (NIRS) to Identify Pediatric Trauma Patients Needing Lifesaving Interventions (LSIs): A Retrospective Study. Pediatr Emerg Care 2022; 38:e193-e199. [PMID: 32910035 DOI: 10.1097/pec.0000000000002211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the role of near-infrared spectroscopy (NIRS) in identifying pediatric trauma patients who required lifesaving interventions (LSIs). METHODS Retrospective chart review of children age 0 to 18 years who activated the trauma team response between January 1, 2015 and August 14, 2017, at a large, urban pediatric emergency department. The lowest somatic NIRS saturation and the need for LSIs (based on published consensus definition) were abstracted from the chart. χ2 and descriptive statistics were used for analysis. RESULTS The charts of 84 pediatric trauma patients were reviewed. Overall, 80% were boys with a mean age of 10.4 years (SD, 6.2 years). Injuries included 56% blunt trauma and 36% penetrating trauma with mortality of 10.7% (n = 9). Overall, the median lowest NIRS value was 67% (interquartile range, 51-80%; range, 15%-95%) and 54.8% of the patients had a NIRS value less than 70%. The median somatic NIRS duration recorded was 12 minutes (interquartile range, 6-17 minutes; range, 1-59 minutes). Overall, 50% of patients required a LSI, including 39 who required a lifesaving procedure, 11 required blood products, and 14 required vasopressors. Pediatric trauma patients with NIRS less than 70% had a significantly increased odds of requiring a LSI (odds ratio, 2.67; 95% confidence interval, 1.10-6.47). NIRS less than 70% had a sensitivity and specificity of 67% and 57% respectively. CONCLUSIONS Pediatric trauma patients with somatic NIRS less than 70% within 30 minutes of emergency department arrival are associated with the need for LSIs. Continuous NIRS monitoring in the pediatric trauma population should be evaluated prospectively.
Collapse
Affiliation(s)
- David W Ashby
- From the Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - David M Gourlay
- Medical College of Wisconsin and Children's Hospital of Wisconsin, Wauwatosa, WI
| | - Binod Balakrishnan
- Medical College of Wisconsin and Children's Hospital of Wisconsin, Wauwatosa, WI
| | - Michael T Meyer
- Medical College of Wisconsin and Children's Hospital of Wisconsin, Wauwatosa, WI
| | - Amy L Drendel
- Medical College of Wisconsin and Children's Hospital of Wisconsin, Wauwatosa, WI
| |
Collapse
|
7
|
Serum NT-Pro-BNP versus Noninvasive Bedside Inotropic Index in Paediatric Shock: A Contest of Myocardial Performance in Response to Fluid Loading. Crit Care Res Pract 2021; 2021:7458186. [PMID: 34888103 PMCID: PMC8651364 DOI: 10.1155/2021/7458186] [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] [Received: 06/11/2021] [Revised: 10/19/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Mild elevation of serum amino-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is associated with myocardial dysfunction. A significantly lower Smith-Madigan inotropic index (SMII) has been shown to accurately represent cardiac contractility among heart failure subjects. We aim to monitor the effect of fluid resuscitation on cardiac function among paediatric patients by measuring serum NT-pro-BNP and SMII. Methods This is an observational study on 70 paediatric shock patients. NT-pro-BNP and noninvasive bedside haemodynamic monitoring were done by using an ultrasonic cardiac output monitor (USCOM, USCOM, Sydney, Australia). The presence of cardiac diseases was excluded. SMII was obtained from the USCOM. An increase in the stroke volume index (SVI) of ≥15% indicates fluid responders. Measurements were taken before and after fluid loading. Results Preloading NT-pro-BNP and SMII category were significantly different between the fluid responsiveness group, p=0.001 and p=0.004, respectively. Higher median NT-pro-BNP (preloading NT-pro-BNP of 1175.00 (254.50-9965.00) ng/mL vs. 196.00 (65.00-509.00) ng/mL, p=0.002) was associated with fluid nonresponders (subjects >12 months old). Preloading NT-pro-BNP <242.5 ng/mL was associated with fluid responders (AUC: 0.768 (0.615-0.921), p=0.003), 82.1% sensitivity, and 68.7% specificity for subjects >12 years old. Delta NT-pro-BNP in fluid responders (15.00 (-16.00-950.00) ng/mL) did not differ from fluid nonresponders (505.00 (-797.00-1600.00) ng/mL), p=0.456. Postloading SMII >1.25 W·m-2 was associated with fluid responders (AUC: 0.683 (0.553-0.813), p = 0.011), 61.9% sensitivity, and 66.7% specificity, but not preloading SMII. Fluid responders had a higher mean postloading SMII compared to nonresponders (1.36 ± 0.38 vs. 1.10 ± 0.34, p=0.006). Conclusion Higher NT-pro-BNP and lower SMII in the absence of cardiac diseases were associated with poor response to fluid loading. The SMII is affected by low preload conditions.
Collapse
|
8
|
Amelard R, Robertson AD, Patterson CA, Heigold H, Saarikoski E, Hughson RL. Optical Hemodynamic Imaging of Jugular Venous Dynamics During Altered Central Venous Pressure. IEEE Trans Biomed Eng 2021; 68:2582-2591. [PMID: 33769929 DOI: 10.1109/tbme.2021.3069133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE An optical imaging system is proposed for quantitatively assessing jugular venous response to altered central venous pressure. METHODS The proposed system assesses sub-surface optical absorption changes from jugular venous waveforms with a spatial calibration procedure to normalize incident tissue illumination. Widefield frames of the right lateral neck were captured and calibrated using a novel flexible surface calibration method. A hemodynamic optical model was derived to quantify jugular venous optical attenuation (JVA) signals, and generate a spatial jugular venous pulsatility map. JVA was assessed in three cardiovascular protocols that altered central venous pressure: acute central hypovolemia (lower body negative pressure), venous congestion (head-down tilt), and impaired cardiac filling (Valsalva maneuver). RESULTS JVA waveforms exhibited biphasic wave properties consistent with jugular venous pulse dynamics when time-aligned with an electrocardiogram. JVA correlated strongly (median, interquartile range) with invasive central venous pressure during graded central hypovolemia (r = 0.85, [0.72, 0.95]), graded venous congestion (r = 0.94, [0.84, 0.99]), and impaired cardiac filling (r = 0.94, [0.85, 0.99]). Reduced JVA during graded acute hypovolemia was strongly correlated with reductions in stroke volume (SV) (r = 0.85, [0.76, 0.92]) from baseline (SV: 79 ± 15 mL, JVA: 0.56 ± 0.10 a.u.) to -40 mmHg suction (SV: 59 ± 18 mL, JVA: 0.47 ± 0.05 a.u.; p 0.01). CONCLUSION The proposed non-contact optical imaging system demonstrated jugular venous dynamics consistent with invasive central venous monitoring during three protocols that altered central venous pressure. SIGNIFICANCE This system provides non-invasive monitoring of pressure-induced jugular venous dynamics in clinically relevant conditions where catheterization is traditionally required, enabling monitoring in non-surgical environments.
Collapse
|
9
|
Singh Y, Villaescusa JU, da Cruz EM, Tibby SM, Bottari G, Saxena R, Guillén M, Herce JL, Di Nardo M, Cecchetti C, Brierley J, de Boode W, Lemson J. Recommendations for hemodynamic monitoring for critically ill children-expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:620. [PMID: 33092621 PMCID: PMC7579971 DOI: 10.1186/s13054-020-03326-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardiovascular instability is common in critically ill children. There is a scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children. METHODS Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature-a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document. RESULTS Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached "strong agreement," 20 "weak agreement," and 2 had "no agreement." Six statements were considered as redundant after rephrasing of statements following the first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to a lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus. CONCLUSIONS These expert consensus-based recommendations may be used to guide clinical practice for hemodynamic monitoring in critically ill children, and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.
Collapse
Affiliation(s)
- Yogen Singh
- Department of Pediatrics - Neonatology and Pediatric Cardiology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine, Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Javier Urbano Villaescusa
- Department of Pediatric Intensive Care, Gregorio Marañón Hospital University Hospital, Madrid, Spain
| | - Eduardo M da Cruz
- Department of Pediatrics, Children's Hospital Colorado, Section of Cardiac Intensive Care, The Heart Institute, Pittsburgh, USA
| | - Shane M Tibby
- Department of Pediatric Intensive Care, Evelina London Children's Hospital, London, UK
| | - Gabriella Bottari
- Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù-IRCC, Rome, Italy
| | - Rohit Saxena
- Department of Pediatric and Cardiac Intensive Care, Great Ormond Street Hospital for Children and UCL Institute for Child Health, London, UK
| | - Marga Guillén
- Department of Pediatric Intensive Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jesus Lopez Herce
- Department of Pediatric Intensive Care, Gregorio Marañón Hospital University Hospital, Madrid, Spain
| | - Matteo Di Nardo
- Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù-IRCC, Rome, Italy
| | - Corrado Cecchetti
- Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù-IRCC, Rome, Italy
| | - Joe Brierley
- Department of Pediatric and Cardiac Intensive Care, Great Ormond Street Hospital for Children and UCL Institute for Child Health, London, UK
| | - Willem de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Joris Lemson
- Department of Intensive Care Medicine, Radboud University Medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Extracting the Jugular Venous Pulse from Anterior Neck Contact Photoplethysmography. Sci Rep 2020; 10:3466. [PMID: 32103056 PMCID: PMC7044195 DOI: 10.1038/s41598-020-60317-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/08/2020] [Indexed: 12/03/2022] Open
Abstract
The jugular venous pulse (JVP) is the reference physiological signal used to detect right atrial and central venous pressure (CVP) abnormalities in cardio-vascular diseases (CVDs) diagnosis. Invasive central venous line catheterization has always been the gold standard method to extract it reliably. However, due to all the risks it entails, novel non-invasive approaches, exploiting distance cameras and lasers, have recently arisen to measure the JVP at the external and internal jugular veins. These remote options however, constraint patients to very specific body positions in front of the imaging system, making it inadequate for long term monitoring. In this study, we demonstrate, for the first time, that reflectance photoplethysmography (PPG) can be an alternative for extracting the JVP from the anterior jugular veins, in a contact manner. Neck JVP-PPG signals were recorded from 20 healthy participants, together with reference ECG and arterial finger PPG signals for validation. B-mode ultrasound imaging of the internal jugular vein also proved the validity of the proposed method. The results show that is possible to identify the characteristic a, c, v pressure waves in the novel signals, and confirm their cardiac-cycle timings in consistency with established cardiac physiology. Wavelet coherence values (close to 1 and phase shifts of ±180°) corroborated that neck contact JVP-PPG pulses were negatively correlated with arterial finger PPG. Average JVP waveforms for each subject showed typical JVP pulses contours except for the singularity of an unknown "u" wave occurring after the c wave, in half of the cohort. This work is of great significance for the future of CVDs diagnosis, as it has the potential to reduce the risks associated with conventional catheterization and enable continuous non-invasive point-of-care monitoring of CVP, without restricting patients to limited postures.
Collapse
|
11
|
Cardiac output, heart rate and stroke volume during targeted temperature management after out-of-hospital cardiac arrest: Association with mortality and cause of death. Resuscitation 2019; 142:136-143. [DOI: 10.1016/j.resuscitation.2019.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/21/2022]
|
12
|
de Boode WP, van der Lee R, Horsberg Eriksen B, Nestaas E, Dempsey E, Singh Y, Austin T, El-Khuffash A. The role of Neonatologist Performed Echocardiography in the assessment and management of neonatal shock. Pediatr Res 2018; 84:57-67. [PMID: 30072807 PMCID: PMC6257224 DOI: 10.1038/s41390-018-0081-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
One of the major challenges of neonatal intensive care is the early detection and management of circulatory failure. Routine clinical assessment of the hemodynamic status of newborn infants is subjective and inaccurate, emphasizing the need for objective monitoring tools. An overview will be provided about the use of neonatologist-performed echocardiography (NPE) to assess cardiovascular compromise and guide hemodynamic management. Different techniques of central blood flow measurement, such as left and right ventricular output, superior vena cava flow, and descending aortic flow are reviewed focusing on methodology, validation, and available reference values. Recommendations are provided for individualized hemodynamic management guided by NPE.
Collapse
Affiliation(s)
- Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands.
| | - Robin van der Lee
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Eirik Nestaas
- Institute of Clinical Medicine, Faculty of Medicine, University of, Oslo, Norway
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Eugene Dempsey
- INFANT Centre, Cork University Maternity Hospital, University College, Cork, Ireland
| | - Yogen Singh
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Topun Austin
- Department of Neonatology, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
- Department of Pediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
13
|
Pittarello D, Vida V, Di Gregorio G, Falasco G, Stellin G, Ori C. Comparison between Pressure Recording Analytical Method and Fick Method to Measure Cardiac Output in Pediatric Cardiac Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.2174/2589645801812010008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background:
There is an increased interest in methods of objective cardiac output measurement in pediatric cardiac surgery. Several techniques are available, but have limitations, among the new technologies pressure recording analytical method with MostCare (MostCare-PRAM), a minimally invasive hemodynamic monitoring system, represents a novel arterial pulse contour method that does not require calibration. For this reason, we compared the MostCare-PRAM vs the Fick method for estimation of cardiac output.
Methods:
We studied prospectively 13 pediatric patients who underwent cardiac surgery and compared intraoperatively Cardiac Index (CI) measured with the MostCare-PRAM with the CI measured with the Fick method. We also measured Cardiac Cycle Efficiency (CCE) and maximal arterial pressure/time ratio (dp/dt max) and compared with Fick method.
Results:
The data showed good agreement between CI Fick and CI MostCare-PRAM (r = 0.93 and R2= 0.86; p < 0.0001) and also between CCE (r = 0.82 and R2 = 0.67; p < 0.001) and dp/dt (r = 0.84; R2 = 0.81; p < 0.001) with CI measured with Fick method.
Conclusion:
In pediatric patients submitted to cardiac surgery, the MostCare-PRAM seems to estimate CI with a good level of agreement with the Fick method measurements.
Collapse
|
14
|
The Correlation between the Change in Thoracic Fluid Content and the Change in Patient Body Weight in Fontan Procedure. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3635708. [PMID: 29854747 PMCID: PMC5966686 DOI: 10.1155/2018/3635708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 04/04/2018] [Indexed: 11/24/2022]
Abstract
Background The thoracic fluid content (TFC) and its percent change compared to the baseline (TFCd0%) derived from a bioreactance technique using a noninvasive cardiac output monitoring (NICOM) device correlate well with the amount of fluid removal in patients undergoing hemodialysis and with intraoperative fluid balance in pediatric patients undergoing cardiac surgery. We hypothesized that TFC or TFCd0% would also be a useful indicator allowing fluid management in pediatric patients undergoing a Fontan procedure. Methods The medical records of patients who underwent an elective Fontan procedure were reviewed retrospectively. The intraoperative variables recorded at two time points were used in the analysis: when the NICOM data obtained just after anesthesia induction (T0) and just before transfer of the patient from the operating room to the ICU (T1). The analyzed variables were hemodynamic parameters, TFC, TFCd0%, stroke volume variation, body weight gain, change in the central venous pressure, and difference in the TFC (ΔTFC). Results The correlation coefficient between TFCd0% and body weight gain was 0.546 (p = 0.01); between TFCd0% and body weight gain% 0.572 (p = 0.007); and between TFCd0% and intraoperative fluid balance 0.554 (p = 0.009). The coefficient of determination derived from a linear regression analysis of TFCd0% versus body weight gain was 0.30 (p = 0.01); between TFCd0% and body weight gain% 0.33 (p = 0.007); and between TFCd0% and intraoperative fluid balance 0.31 (p = 0.009). Conclusions TFCd0% correlated well with body weight gain, body weight gain%, and intraoperative fluid balance. It is a useful indicator in the intraoperative fluid management of pediatric patients undergoing a Fontan procedure. Trial Registration This trial is registered with Clinical Research Information Service KCT0002062.
Collapse
|
15
|
Kamoi S, Pretty CG, Chiew YS, Pironet A, Davidson S, Desaive T, Shaw GM, Chase JG. Stroke Volume estimation using aortic pressure measurements and aortic cross sectional area: Proof of concept. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2015:1005-8. [PMID: 26736434 DOI: 10.1109/embc.2015.7318534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Accurate Stroke Volume (SV) monitoring is essential for patient with cardiovascular dysfunction patients. However, direct SV measurements are not clinically feasible due to the highly invasive nature of measurement devices. Current devices for indirect monitoring of SV are shown to be inaccurate during sudden hemodynamic changes. This paper presents a novel SV estimation using readily available aortic pressure measurements and aortic cross sectional area, using data from a porcine experiment where medical interventions such as fluid replacement, dobutamine infusions, and recruitment maneuvers induced SV changes in a pig with circulatory shock. Measurement of left ventricular volume, proximal aortic pressure, and descending aortic pressure waveforms were made simultaneously during the experiment. From measured data, proximal aortic pressure was separated into reservoir and excess pressures. Beat-to-beat aortic characteristic impedance values were calculated using both aortic pressure measurements and an estimate of the aortic cross sectional area. SV was estimated using the calculated aortic characteristic impedance and excess component of the proximal aorta. The median difference between directly measured SV and estimated SV was -1.4ml with 95% limit of agreement +/- 6.6ml. This method demonstrates that SV can be accurately captured beat-to-beat during sudden changes in hemodynamic state. This novel SV estimation could enable improved cardiac and circulatory treatment in the critical care environment by titrating treatment to the effect on SV.
Collapse
|
16
|
Balmer J, Pretty C, Davidson S, Desaive T, Habran S, Chase JG. Effect of arterial pressure measurement location on pulse contour stroke volume estimation, during a rapid change in hemodynamic state. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.ifacol.2018.11.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
17
|
Vrancken SL, van Heijst AF, de Boode WP. Neonatal Hemodynamics: From Developmental Physiology to Comprehensive Monitoring. Front Pediatr 2018; 6:87. [PMID: 29675404 PMCID: PMC5895966 DOI: 10.3389/fped.2018.00087] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/19/2018] [Indexed: 12/16/2022] Open
Abstract
Maintenance of neonatal circulatory homeostasis is a real challenge, due to the complex physiology during postnatal transition and the inherent immaturity of the cardiovascular system and other relevant organs. It is known that abnormal cardiovascular function during the neonatal period is associated with increased risk of severe morbidity and mortality. Understanding the functional and structural characteristics of the neonatal circulation is, therefore, essential, as therapeutic hemodynamic interventions should be based on the assumed underlying (patho)physiology. The clinical assessment of systemic blood flow (SBF) by indirect parameters, such as blood pressure, capillary refill time, heart rate, urine output, and central-peripheral temperature difference is inaccurate. As blood pressure is no surrogate for SBF, information on cardiac output and systemic vascular resistance should be obtained in combination with an evaluation of end organ perfusion. Accurate and reliable hemodynamic monitoring systems are required to detect inadequate tissue perfusion and oxygenation at an early stage before this result in irreversible damage. Also, the hemodynamic response to the initiated treatment should be re-evaluated regularly as changes in cardiovascular function can occur quickly. New insights in the understanding of neonatal cardiovascular physiology are reviewed and several methods for current and future neonatal hemodynamic monitoring are discussed.
Collapse
Affiliation(s)
- Sabine L Vrancken
- Department of Perinatology (Neonatology), Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Arno F van Heijst
- Department of Perinatology (Neonatology), Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Willem P de Boode
- Department of Perinatology (Neonatology), Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
18
|
Abstract
Anesthesia can lead to pathophysiologic changes that dramatically alter the fluid balance of the body compartments and the intravascular space. Fluid administration can be monitored and evaluated using static and dynamic indexes. Guidelines for fluid rates during anesthesia begin with 3 mL/kg/h in cats and 5 mL/kg/h in dogs. If at all possible, patients should be stabilized and electrolyte disturbances should be corrected before general anesthesia.
Collapse
|
19
|
Fletcher-Sandersjöö A, Bartek J, Thelin EP, Eriksson A, Elmi-Terander A, Broman M, Bellander BM. Predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation: an observational cohort study. J Intensive Care 2017; 5:27. [PMID: 28546860 PMCID: PMC5441045 DOI: 10.1186/s40560-017-0223-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/12/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intracranial hemorrhage (ICH) is a recognized complication of adults treated with extracorporeal membrane oxygenation (ECMO) and is associated with increased morbidity and mortality. However, the predictors of ICH in this patient category are poorly understood. The purpose of this study was to identify predictors of ICH in ECMO-treated adult patients. METHODS We conducted a retrospective review of adult patients (≥18 years) treated with ECMO at the Karolinska University Hospital (Stockholm, Sweden) between September 2005 and June 2016, excluding patients with ICH upon admission or those who were treated with ECMO for less than 12 h. In a comparative analysis, the primary end-points were the difference in baseline characteristics and predictors of hemorrhage occurrence (ICH vs. non-ICH cohorts). The secondary end-point was difference in mortality between groups. Paired testing and uni- and multivariate regression models were applied. RESULTS Two hundred and fifty-three patients were included, of which 54 (21%) experienced an ICH during ECMO treatment. The mortality for patients with ICH was 81% at 1 month and 85% at 6 months, respectively, compared to 28 and 33% in patients who did not develop ICH. When comparing ICH vs. non-ICH cohorts, pre-admission antithrombotic therapy (p = 0.018), high pre-cannulation Sepsis-related Organ Failure Assessment (SOFA) coagulation score (p = 0.015), low platelet count (p < 0.001), and spontaneous extracranial hemorrhage (p = 0.045) were predictors of ICH. In a multivariate regression model predicting ICH, pre-admission antithrombotic therapy and low platelet count demonstrated independent risk association. When comparing the temporal trajectories for coagulation variables in the days leading up to the detection of an ICH, plasma antithrombin significantly increased per patient over time (p = 0.014). No other temporal trajectories were found. CONCLUSIONS ICH in adult ECMO patients is associated with a high mortality rate and independently associated with pre-admission antithrombotic therapy and low platelet count, thus highlighting important areas of potential treatment strategies to prevent ICH development.
Collapse
Affiliation(s)
- Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Eric Peter Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Anders Eriksson
- ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | | | - Mikael Broman
- ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Bo-Michael Bellander
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
20
|
Kamoi S, Pretty C, Balmer J, Davidson S, Pironet A, Desaive T, Shaw GM, Chase JG. Improved pressure contour analysis for estimating cardiac stroke volume using pulse wave velocity measurement. Biomed Eng Online 2017; 16:51. [PMID: 28438216 PMCID: PMC5404318 DOI: 10.1186/s12938-017-0341-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/19/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pressure contour analysis is commonly used to estimate cardiac performance for patients suffering from cardiovascular dysfunction in the intensive care unit. However, the existing techniques for continuous estimation of stroke volume (SV) from pressure measurement can be unreliable during hemodynamic instability, which is inevitable for patients requiring significant treatment. For this reason, pressure contour methods must be improved to capture changes in vascular properties and thus provide accurate conversion from pressure to flow. METHODS This paper presents a novel pressure contour method utilizing pulse wave velocity (PWV) measurement to capture vascular properties. A three-element Windkessel model combined with the reservoir-wave concept are used to decompose the pressure contour into components related to storage and flow. The model parameters are identified beat-to-beat from the water-hammer equation using measured PWV, wave component of the pressure, and an estimate of subject-specific aortic dimension. SV is then calculated by converting pressure to flow using identified model parameters. The accuracy of this novel method is investigated using data from porcine experiments (N = 4 Pietrain pigs, 20-24.5 kg), where hemodynamic properties were significantly altered using dobutamine, fluid administration, and mechanical ventilation. In the experiment, left ventricular volume was measured using admittance catheter, and aortic pressure waveforms were measured at two locations, the aortic arch and abdominal aorta. RESULTS Bland-Altman analysis comparing gold-standard SV measured by the admittance catheter and estimated SV from the novel method showed average limits of agreement of ±26% across significant hemodynamic alterations. This result shows the method is capable of estimating clinically acceptable absolute SV values according to Critchely and Critchely. CONCLUSION The novel pressure contour method presented can accurately estimate and track SV even when hemodynamic properties are significantly altered. Integrating PWV measurements into pressure contour analysis improves identification of beat-to-beat changes in Windkessel model parameters, and thus, provides accurate estimate of blood flow from measured pressure contour. The method has great potential for overcoming weaknesses associated with current pressure contour methods for estimating SV.
Collapse
Affiliation(s)
- Shun Kamoi
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Christopher Pretty
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Joel Balmer
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Shaun Davidson
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Antoine Pironet
- GIGA Cardiovascular Science, University of Liege, Liege, Belgium
| | - Thomas Desaive
- GIGA Cardiovascular Science, University of Liege, Liege, Belgium
| | - Geoffrey M. Shaw
- Intensive Care Unit, Christchurch Hospital, Christchurch, New Zealand
| | - J. Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
21
|
Narula J, Chauhan S, Ramakrishnan S, Gupta SK. Electrical Cardiometry: A Reliable Solution to Cardiac Output Estimation in Children With Structural Heart Disease. J Cardiothorac Vasc Anesth 2016; 31:912-917. [PMID: 28262447 DOI: 10.1053/j.jvca.2016.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Comparison of cardiac output (CO) obtained using electric cardiometry (EC) and pulmonary artery catheterization (PAC) in pediatric patients with congenital structural heart disease. DESIGN Prospective, observational study. SETTING A tertiary hospital. PARTICIPANTS The study comprised 50 patients scheduled to undergo cardiac catheterization. INTERVENTIONS CO data triplets were obtained simultaneously from the cardiometry device ICON (Osypka Medical, Berlin, Germany) and PAC at the following predefined time points-(1) T1: 5 minutes after arterial and venous cannulation and (2) T2: 5 minutes postprocedure; the average of the 3 readings was calculated. Reliability analysis and Bland-Altman analysis were performed to determine the limits of agreement, mean bias, and accuracy of the CO measured with EC. MEASUREMENTS AND MAIN RESULTS The measured EC-cardiac index 4.22 (3.84-4.60) L/min/m2 and PAC-cardiac index 4.26 (3.67-4.67) L/min/m2 were statistically insignificant (p value>0.05) at T1. Bland-Altman analysis revealed a mean bias of 0.0051 L/min/m2 and precision limits of±0.4927 L/min/m2. The intraclass correlation coefficient was 0.789 and Cronbach's alpha was 0.652, indicating good reproducibility and internal consistency between the two techniques. Postcatheterization analysis also revealed strong agreement and reliability between the two techniques. CONCLUSIONS This study demonstrated that cardiac indices measured in children with a variety of structural heart diseases using EC reliably represent absolute values obtained using PAC. EC technology is simple and easy to use and offers noninvasive beat-to-beat tracking of CO and other hemodynamic parameters in children with structurally abnormal hearts.
Collapse
Affiliation(s)
- Jitin Narula
- Department of Cardiac Anesthesiology, Cardio and Neuro Sciences Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Sandeep Chauhan
- Department of Cardiac Anesthesiology, Cardio and Neuro Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sivasubramanian Ramakrishnan
- Department of Cardiology, Cardio and Neuro Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, Cardio and Neuro Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
22
|
Kuiper JW, Tibboel D, Ince C. The vulnerable microcirculation in the critically ill pediatric patient. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:352. [PMID: 27794361 PMCID: PMC5086412 DOI: 10.1186/s13054-016-1496-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In neonates, cardiovascular system development does not stop after the transition from intra-uterine to extra-uterine life and is not limited to the macrocirculation. The microcirculation (MC), which is essential for oxygen, nutrient, and drug delivery to tissues and cells, also develops. Developmental changes in the microcirculatory structure continue to occur during the initial weeks of life in healthy neonates. The physiologic hallmarks of neonates and developing children make them particularly vulnerable during critical illness; however, the cardiovascular monitoring possibilities are limited compared with critically ill adult patients. Therefore, the development of non-invasive methods for monitoring the MC is necessary in pediatric critical care for early identification of impending deterioration and to enable the initiation and titration of therapy to ensure cell survival. To date, the MC may be non-invasively monitored at the bedside using hand-held videomicroscopy, which provides useful information regarding the microcirculation. There is an increasing number of studies on the MC in neonates and pediatric patients; however, additional steps are necessary to transition MC monitoring from bench to bedside. The recently introduced concept of hemodynamic coherence describes the relationship between changes in the MC and macrocirculation. The loss of hemodynamic coherence may result in a depressed MC despite an improvement in the macrocirculation, which represents a condition associated with adverse outcomes. In the pediatric intensive care unit, the concept of hemodynamic coherence may function as a framework to develop microcirculatory measurements towards implementation in daily clinical practice.
Collapse
Affiliation(s)
- J W Kuiper
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Postbox 2040, 3000 CA, Rotterdam, The Netherlands.
| | - D Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Postbox 2040, 3000 CA, Rotterdam, The Netherlands
| | - C Ince
- Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| |
Collapse
|
23
|
Abstract
OBJECTIVES The objectives of this review are to discuss the technology and clinical interpretation of near infrared spectroscopy oximetry and its clinical application in patients with congenital heart disease. DATA SOURCE MEDLINE and PubMed. CONCLUSION Near infrared spectroscopy provides a continuous noninvasive assessment of tissue oxygenation. Over 20 years ago, near infrared spectroscopy was introduced into clinical practice for monitoring cerebral oxygenation during cardiopulmonary bypass in adults. Since that time, the utilization of near infrared spectroscopy has extended into the realm of pediatric cardiac surgery and is increasingly being used in the cardiac ICU to monitor tissue oxygenation perioperatively.
Collapse
|
24
|
Urbano J, López J, González R, Fernández SN, Solana MJ, Toledo B, Carrillo Á, López-Herce J. Comparison between pressure-recording analytical method (PRAM) and femoral arterial thermodilution method (FATD) cardiac output monitoring in an infant animal model of cardiac arrest. Intensive Care Med Exp 2016; 4:13. [PMID: 27256288 PMCID: PMC4891310 DOI: 10.1186/s40635-016-0087-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/26/2016] [Indexed: 02/06/2023] Open
Abstract
Background The pressure-recording analytical method is a new semi-invasive method for cardiac output measurement (PRAM). There are no studies comparing this technique with femoral artery thermodilution (FATD) in an infant animal model. Methods A prospective study was performed using 25 immature Maryland pigs weighing 9.5 kg. Fifty-eight simultaneous measurements of cardiac index (CI) were made by FATD and PRAM at baseline and after return of spontaneous circulation. Differences, correlation, and concordance between both methods were analyzed. The ability of PRAM to track changes in CI was explored with a polar plot. Results Mean CI measurements were 4.5 L/min/m2 (95 % CI, 4.2–4.8 L/min/m2; coefficient of variation, 27 %) by FATD and 4.0 L/min/m2 (95 % CI, 3.6–4.3 L/min/m2; coefficient for variation, 37 %) by PRAM (difference, 0.5 L/min/m2; 95 % CI for the difference, 0.1–1.0 L/min/m2; p = 0.003; n = 58). No correlation between both methods was observed (r = 0.170, p = 0.20). Limits of agreement were −2.9 to 4.0 L/min/m2 (−69.9 to 84.9 %). Percentage error was 80.6 %. Only 26.1 % of data points lied within an absolute deviation of ±30° from the polar axis. Conclusions No correlation nor concordance between both methods was observed. Limits of agreement and percentage of error were high and clinically not acceptable. No concurrence between both methods in CI changes was observed. PRAM is not a useful method for measurement of the CI in this pediatric model of cardiac arrest.
Collapse
Affiliation(s)
- Javier Urbano
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Jorge López
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Rafael González
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Sarah N Fernández
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - María José Solana
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Blanca Toledo
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Ángel Carrillo
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain. .,Universidad Complutense, Madrid, Spain. .,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain.
| |
Collapse
|
25
|
Linden K, Ladage D, Dewald O, Gatzweiler E, Pieper A, Seehase M, Duerr GD, Breuer J, Herberg U. Comparison of stroke volumes assessed by three-dimensional echocardiography and transpulmonary thermodilution in a pediatric animal model. J Clin Monit Comput 2016; 31:353-360. [PMID: 26886899 DOI: 10.1007/s10877-016-9843-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/14/2016] [Indexed: 02/02/2023]
Abstract
To compare stroke volumes (SV) in small hearts assessed by real-time three-dimensional echocardiography (3DE) with SV measured by transpulmonary thermodilution (TPTD) and continuous pulse contour analysis (PC) under various hemodynamic conditions. In thirteen anesthetized piglets (range 3.6-7.1 kg) SV were measured by 3DE, TPTD and PC at baseline and during phenylephrine and esmolol administration. 3DE and TPTD measurements were done successively while SV calculated by PC was documented at the time of 3DE. 3DE and TPTD showed a good correlation (r2 = 0.74) and a bias of -1.3 ml (limits of agreement -4.1 to 1.5 ml). While TPTD measured higher SV than 3DE, both methods tracked SV changes with a concordance rate of 91 %. PC and 3DE showed a lower correlation coefficient of r2 = 0.57 and a bias of -2.1 ml (limits of agreement -5.9 to 1.8 ml). Inter- and intra-observer variability of SV measured by 3DE was good with a mean bias <5 %. SV3DE showed a small variance and tracked acute small changes in SV in acceptable concordance with TPTD. PC measured SV with a higher variance and mean difference compared to 3DE. In an experimental setting 3DE has the possibility to offer non-invasive assessments of ventricular volumes volume changes. To determine whether 3DE could be used for SV assessment in a clinical routine our results need confirmation in a clinical setting.
Collapse
Affiliation(s)
- Katharina Linden
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
| | - Dennis Ladage
- Department of Internal Medicine III, Heart Center, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, Pediatric Heart Center, University Clinical Center Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Eva Gatzweiler
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Andrea Pieper
- House of Experimental Therapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Matthias Seehase
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiac Surgery, Pediatric Heart Center, University Clinical Center Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, Pediatric Heart Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| |
Collapse
|
26
|
Hernández-Benítez R, Becerra-Becerra R. [Functional echocardiography in the neonatal intensive care unit; experience in a tertiary level hospital]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:325-330. [PMID: 29384125 DOI: 10.1016/j.bmhimx.2016.07.003] [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: 04/19/2016] [Revised: 07/04/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The Hospital Infantil de Mexico Federico Gómez is a tertiary level hospital with a neonatal intensive care unit (NICU), which is one of the most important units in the treatment of newborn's diseases in México. In this unit, the decisions are taken based on some clinic parameters such as respiratory rate, heart rate, arterial pressure, urinary output and lactate levels. The functional echocardiography is a useful tool which improves the hemodynamic evaluation and decisions in neonatal care. Data on its use in neonatal units in Mexico is lacking. METHODS A prospective study conducted in NICU patients during 3 months from August to October 2015 at the Hospital Infantil de Mexico Federico Gómez. Gestational age, birth weight, admission criteria, days of life at examination, indication for functional echocardiography and changes in treatment were evaluated and finally, we performed a new study 24hours later. Echocardiographic evaluation included: assessment of presence/hemodynamic significance of PDA; myocardial function: ejection fraction/shortening fraction, left ventricular output, right ventricular output, systemic blood flow; and signs of pulmonary hypertension. RESULTS 30 echocardiographic studies were performed in 15 patients. The average age was 9.6 days, the variability in gestational ages were 37 to 42 weeks; the average weight was 2.583kg. The most frequent diagnosis was respiratory distress, and the principal indications for echocardiography were hemodynamic instability and sepsis (53.3%). In 11 cases (73.3%), the treatment was modified posteriorly to functional echocardiography, and in 10 cases we observed improvements in the 24hours after control. CONCLUSIONS Functional echocardiography is a useful tool in NICU, which may assist with clinical decision-making.
Collapse
Affiliation(s)
| | - Rosario Becerra-Becerra
- Departamento de Cardiología del Hospital Infantil de México Federico Gómez, Ciudad de México, México
| |
Collapse
|
27
|
Beltramo F, Menteer J, Razavi A, Khemani RG, Szmuszkovicz J, Newth CJL, Ross PA. Validation of an Ultrasound Cardiac Output Monitor as a Bedside Tool for Pediatric Patients. Pediatr Cardiol 2016; 37:177-83. [PMID: 26364291 DOI: 10.1007/s00246-015-1261-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/27/2015] [Indexed: 12/13/2022]
Abstract
The aim of our study was to determine the validity of cardiac output (CO) measurements taken with the ultrasonic cardiac output monitor (USCOM) by comparing to CO measured by pulmonary arterial catheter (PAC) thermodilution during cardiac catheterization. We enrolled thirty-one children (<18 years) undergoing cardiac catheterization in this double-blinded, prospective, observational study. The median CO measured by USCOM was 4.37 L/min (IQR 3.73, 5.60 L/min) compared to 4.28 L/min (IQR 3.52, 5.26 L/min) by PAC thermodilution. The bias (mean difference) between the two methods was 0.2 L/min, and the 95% limits of agreement were -1.2 to 1.6 L/min. The mean percentage error of CO between USCOM and PAC thermodilution was 11%. When excluding a sole outlier, the bias between the two measures decreased to 0.1 L/min (95% limits of agreement -0.6 to 0.9 L/min), and the percentage error was reduced to 8%. The median SVRI measured by USCOM was 22.0 Wood Units (IQR 17.0, 26.8 Wood Units) compared to 22.1 Wood Units (IQR 17.6, 27.4 Wood Units) by PAC thermodilution. Bias (mean difference) between the two methods was -0.6 Wood Units, and the 95% limits of agreement were -8.2 to 6.9 Wood Units. We found that the estimation of CO and by extension SVRI with USCOM is reliable against pulmonary artery catheter thermodilution in children with normal cardiac anatomy. Given the noninvasive nature of USCOM, speed of measurement, and relative ease of use, it may be useful as a bedside tool for pediatric patients.
Collapse
Affiliation(s)
- Fernando Beltramo
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA
| | - Jondavid Menteer
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Asma Razavi
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA
| | - Robinder G Khemani
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jacqueline Szmuszkovicz
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Christopher J L Newth
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Patrick A Ross
- Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop # 3, Los Angeles, CA, 90027, USA. .,University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| |
Collapse
|
28
|
The Role of Regional Oxygen Saturation Using Near-Infrared Spectroscopy and Blood Lactate Levels as Early Predictors of Outcome After Pediatric Cardiac Surgery. Can J Cardiol 2015; 32:970-7. [PMID: 26868838 DOI: 10.1016/j.cjca.2015.09.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the association between regional oxygen saturation (rSO2) desaturation score (calculated by multiplying the rSO2 < 50% by time in seconds the preoperative baseline value) measured with near-infrared spectroscopy and the peak of lactate with postoperative major morbidities in pediatric patients who undergo cardiac surgery. METHODS We retrospectively analyzed the postoperative course of 152 patients between January 2012 and December 2013, for whom we continuously monitored cerebral rSO2 using near-infrared spectroscopy and serial arterial blood lactate levels for at least 48 hours. RESULTS The median age at surgery was 128 days (interquartile range [IQR], 17-537 days). Thirty-nine patients had a single ventricle physiology (26%) and 135 patients (89%) required the use of cardiopulmonary bypass (median time of 130 minutes; IQR, 93-172 minutes). Median postoperative peak lactate level was 3 mmol/L (IQR, 2-5.3 mmol/L); 52 patients (34%) had a postoperative lactate level > 4.6 mmol/L. The median postoperative rSO2 desaturation score was 157 (IQR, 0-2050); 62 patients (41%) had an rSO2 desaturation score > 345. Fifty-seven patients (37%) had postoperative major morbidities. Using a multivariable regression model only rSO2 desaturation score > 345 was independently associated with major morbidities after surgery (odds ratio, 27.26; 95% confidence interval, 10.18-73.00). The proportion of patients with an rSO2 desaturation score > 345 within 240 minutes after surgery was higher than the rate of those who showed a peak of lactate > 4.6 mmol/L (84% vs 59%; P = 0.05). CONCLUSIONS The postoperative rSO2 desaturation score has a stronger association with major postoperative morbidities than lactate and it also provides an earlier warning sign of hemodynamic or metabolic compromise.
Collapse
|
29
|
Abstract
This review offers a critical-care perspective on the pathophysiology, monitoring, and management of acute heart failure syndromes in children. An in-depth understanding of the cardiovascular physiological disturbances in this population of patients is essential to correctly interpret clinical signs, symptoms and monitoring data, and to implement appropriate therapies. In this regard, the myocardial force-velocity relationship, the Frank-Starling mechanism, and pressure-volume loops are discussed. A variety of monitoring modalities are used to provide insight into the haemodynamic state, clinical trajectory, and response to treatment. Critical-care treatment of acute heart failure is based on the fundamental principles of optimising the delivery of oxygen and minimising metabolic demands. The former may be achieved by optimising systemic arterial oxygen content and the variables that determine cardiac output: heart rate and rhythm, preload, afterload, and contractility. Metabolic demands may be decreased by a number of ways including positive pressure ventilation, temperature control, and sedation. Mechanical circulatory support should be considered for refractory cases. In the near future, monitoring modalities may be improved by the capture and analysis of complex clinical data such as pressure waveforms and heart rate variability. Using predictive modelling and streaming analytics, these data may then be used to develop automated, real-time clinical decision support tools. Given the barriers to conducting multi-centre trials in this population of patients, the thoughtful analysis of data from multi-centre clinical registries and administrative databases will also likely have an impact on clinical practice.
Collapse
|
30
|
Summary of the 2015 International Paediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute. Cardiol Young 2015; 25 Suppl 2:8-30. [PMID: 26377707 DOI: 10.1017/s1047951115001353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children's Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children's Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary "think-tank". The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute, to describe the "state of the art" of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.
Collapse
|
31
|
Vergnaud E, Vidal C, Verchere JM, Taright H, Meyer PG, Carli PA, Orliaguet GA. Noninvasive cardiac output measurement using bioreactance in postoperative pediatric patients. Paediatr Anaesth 2015; 25:160-6. [PMID: 24814690 DOI: 10.1111/pan.12412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Thoracic bioreactance is a noninvasive and continuous method of cardiac output (CO) measurement that is being developed in adult patients. Very little information is available on thoracic bioreactance use in children. OBJECTIVE The aim of the study was to evaluate the ability of a bioreactance device (NICOM(®) ; Cheetah Medical, Tel Aviv, Israel) to estimate CO and to track changes in CO induced by volume expansion (VE) in children. METHODS Cardiac output values obtained using the NICOM(®) device (CONICOM ) and measured by trans-thoracic echocardiography (COTTE ) were compared in pediatric neurosurgical patients during the postoperative period. RESULTS Seventy-three pairs of measurements of CO obtained in 30 children were available for analysis. The bias (lower and upper limits of agreement) between CONICOM and COTTE was -0.11 (-1.4 to 1.2) l·min(-1). The percentage error (PE) was 55%. The precision of the NICOM(®) device was 45%. A significant correlation was observed between the CO values obtained using the two methods (r = 0.89, <0.001). The concordance percentage between changes in COTTE and CON icom induced by VE was 84% following exclusion of patients with changes in CO <15% (n = 5). CONCLUSIONS The PE observed is too large, and the limits of agreement too wide, to enable us to comment on the equivalence of the two techniques of CO measurements. However, the NICOM(®) device performs well in tracking changes in CO following VE.
Collapse
Affiliation(s)
- Estelle Vergnaud
- Service d'Anesthésie Réanimation, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | | |
Collapse
|
32
|
Urbano J, López J, González R, Solana MJ, Fernández SN, Bellón JM, López-Herce J. Measurement of cardiac output in children by pressure-recording analytical method. Pediatr Cardiol 2015; 36:358-64. [PMID: 25179459 DOI: 10.1007/s00246-014-1014-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 08/22/2014] [Indexed: 12/13/2022]
Abstract
We evaluated two pressure-recording analytical method (PRAM) software versions (v.1 and v.2) to measure cardiac index (CI) in hemodynamically stable critically ill children and investigate factors that influence PRAM values. The working hypothesis was that PRAM CI measurements would stay within normal limits in hemodynamically stable patients. Ninety-five CI PRAM measurements were analyzed in 47 patients aged 1-168 months. Mean CI was 4.1 ± 1.4 L/min/m(2) (range 2.0-7.0). CI was outside limits defined as normal (3-5 L/min/m(2)) in 53.7% of measurements (47.8% with software v.1 and 69.2% with software v.2, p = 0.062). Moreover, 14.7% of measurements were below 2.5 L/min/m(2), and 13.6% were above 6 L/min/m(2). CI was significantly lower in patients with a clearly visible dicrotic notch than in those without (3.7 vs. 4.6 L/min/m(2), p = 0.004) and in children with a radial arterial catheter (3.5 L/min/m(2)) than in those with a brachial (4.4 L/min/m(2), p = 0.021) or femoral catheter (4.7 L/min/m(2), p = 0.005). By contrast, CI was significantly higher in children under 12 months (4.2 vs. 3.6 L/min/m(2), p = 0.034) and weighing under 10 kg (4.2 vs. 3.6 L/min/m(2), p = 0.026). No significant differences were observed between cardiac surgery patients and the rest of children. A high percentage of CI measurements registered by PRAM were outside normal limits in hemodynamically stable, critically ill children. CI measured by PRAM may be influenced by the age, weight, location of catheter, and presence of a dicrotic notch.
Collapse
Affiliation(s)
- Javier Urbano
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del, Hospital General Universitario Gregorio Marañón de Madrid, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
33
|
Kamoi S, Pretty C, Docherty P, Squire D, Revie J, Chiew YS, Desaive T, Shaw GM, Chase JG. Continuous stroke volume estimation from aortic pressure using zero dimensional cardiovascular model: proof of concept study from porcine experiments. PLoS One 2014; 9:e102476. [PMID: 25033442 PMCID: PMC4102500 DOI: 10.1371/journal.pone.0102476] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 06/18/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Accurate, continuous, left ventricular stroke volume (SV) measurements can convey large amounts of information about patient hemodynamic status and response to therapy. However, direct measurements are highly invasive in clinical practice, and current procedures for estimating SV require specialized devices and significant approximation. Method This study investigates the accuracy of a three element Windkessel model combined with an aortic pressure waveform to estimate SV. Aortic pressure is separated into two components capturing; 1) resistance and compliance, 2) characteristic impedance. This separation provides model-element relationships enabling SV to be estimated while requiring only one of the three element values to be known or estimated. Beat-to-beat SV estimation was performed using population-representative optimal values for each model element. This method was validated using measured SV data from porcine experiments (N = 3 female Pietrain pigs, 29–37 kg) in which both ventricular volume and aortic pressure waveforms were measured simultaneously. Results The median difference between measured SV from left ventricle (LV) output and estimated SV was 0.6 ml with a 90% range (5th–95th percentile) −12.4 ml–14.3 ml. During periods when changes in SV were induced, cross correlations in between estimated and measured SV were above R = 0.65 for all cases. Conclusion The method presented demonstrates that the magnitude and trends of SV can be accurately estimated from pressure waveforms alone, without the need for identification of complex physiological metrics where strength of correlations may vary significantly from patient to patient.
Collapse
Affiliation(s)
- Shun Kamoi
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
- * E-mail:
| | - Christopher Pretty
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Paul Docherty
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Dougie Squire
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - James Revie
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Yeong Shiong Chiew
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Thomas Desaive
- GIGA Cardiovascular Science, University of Liege, Liege, Belgium
| | - Geoffrey M. Shaw
- Intensive Care Unit, Christchurch Hospital, Christchurch, New Zealand
| | - J. Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
34
|
Dhillon S, Yu X, Zhang G, Cai S, Li J. Clinical Hemodynamic Parameters Do Not Accurately Reflect Systemic Oxygen Transport in Neonates after the Norwood Procedure. CONGENIT HEART DIS 2014; 10:234-9. [DOI: 10.1111/chd.12196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Santokh Dhillon
- Division of Pediatric Cardiology; Department of Pediatrics; Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
| | - Xiaoyang Yu
- Division of Pediatric Cardiology; Department of Pediatrics; Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
| | - Gencheng Zhang
- Division of Cardiovascular Surgery; Hospital for Sick Children; Toronto Ontario Canada
| | - Sally Cai
- Congenital Heart Surgeons' Society Data Center; Hospital for Sick Children; Toronto Ontario Canada
| | - Jia Li
- Clinical Physiology Research Center; Capital Institute of Pediatrics; Beijing China
| |
Collapse
|
35
|
Cardiogenic weight oscillation, a novel phenomenon. Int J Cardiol 2014; 172:e292. [PMID: 24485626 DOI: 10.1016/j.ijcard.2013.12.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/28/2013] [Indexed: 11/22/2022]
|
36
|
Nusmeier A, van der Hoeven JG, Lemson J. Cardiac output monitoring in pediatric patients. Expert Rev Med Devices 2014; 7:503-17. [DOI: 10.1586/erd.10.19] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
37
|
Kamoi S, Squire D, Revie J, Pretty C, Docherty P, Chiew YS, Desaive T, Shaw GM, Chase JG. Accuracy of Stroke Volume Estimation via Reservoir Pressure Concept and Three Element Windkessel Model. ACTA ACUST UNITED AC 2014. [DOI: 10.3182/20140824-6-za-1003.01104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
38
|
Vallet B, Blanloeil Y, Cholley B, Orliaguet G, Pierre S, Tavernier B. Guidelines for perioperative haemodynamic optimization. ACTA ACUST UNITED AC 2013; 32:e151-8. [PMID: 24126197 DOI: 10.1016/j.annfar.2013.09.010] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- B Vallet
- Pôle d'anesthésie réanimation, hôpital Huriez, CHRU de Lille, rue Polonovski, 59037 Lille cedex, France.
| | | | | | | | | | | | | |
Collapse
|
39
|
Rossi AF, Checchia PA, Lopez L, Seiden HS, Burke RP. Web-based survey of current trends in hemodynamic monitoring after congenital heart surgery. World J Pediatr Congenit Heart Surg 2013; 3:301-9. [PMID: 23804861 DOI: 10.1177/2150135111433472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Strategies for monitoring patients recovering after congenital heart surgery have evolved considerably as technology continues to progress. Monitoring techniques traditionally centered around the comprehensive physical examination have been replaced by a number of revolutionary technologies developed to objectively evaluate various components of the cardiovascular system. Despite scant evidence that these methodologies actually improve outcomes, some have been embraced by clinicians. We developed an Internet survey designed to describe current practices of clinicians who care for patients after congenital heart surgery. There were 162 respondents to our survey with the majority from the United States. The views of cardiologists, intensivists, those dual trained in both cardiology and critical care medicine, and surgeons are all robustly represented in the results. Serial lactate monitoring was the strategy that was utilized most often by respondents (94%), followed by multisite near-infrared spectrometry (NIRS, 67%). There were 78% who utilized the combination of serial lactate and NIRS monitoring. Serial lactate monitoring was the technique that was thought to best represent cardiovascular well-being after heart surgery (40%). The results of this survey suggest that despite the paucity of evidence that clinical outcomes of patients recovering after congenital heart surgery are improved by any of these monitoring techniques, there is almost universal acceptance to monitor patients with serial lactate monitoring, NIRS monitoring, or a combination of these techniques.
Collapse
Affiliation(s)
- Anthony F Rossi
- Departments of Cardiology and Cardiac Surgery, Miami Children's Hospital, Miami, FL, USA
| | | | | | | | | |
Collapse
|
40
|
Salgado DR, Silva E, Vincent JL. Control of hypertension in the critically ill: a pathophysiological approach. Ann Intensive Care 2013; 3:17. [PMID: 23806076 PMCID: PMC3704960 DOI: 10.1186/2110-5820-3-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/14/2013] [Indexed: 01/21/2023] Open
Abstract
Severe acute arterial hypertension can be associated with significant morbidity and mortality. After excluding a reversible etiology, choice of therapeutic intervention should be based on evaluation of a number of factors, such as age, comorbidities, and other ongoing therapies. A rational pathophysiological approach should then be applied that integrates the effects of the drug on blood volume, vascular tone, and other determinants of cardiac output. Vasodilators, calcium channel blockers, and beta-blocking agents can all decrease arterial pressure but by totally different modes of action, which may be appropriate or contraindicated in individual patients. There is no preferred agent for all situations, although some drugs may have a more attractive profile than others, with rapid onset action, short half-life, and fewer adverse reactions. In this review, we focus on the main mechanisms underlying severe hypertension in the critically ill and how using a pathophysiological approach can help the intensivist decide on treatment options.
Collapse
Affiliation(s)
- Diamantino Ribeiro Salgado
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, Brussels 1070, Belgium
- Dept of Internal Medicine, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255 Sala 4A, Rio de Janeiro 12-21941-913, Brazil
| | - Eliezer Silva
- Intensive Care Unit, Albert Einstein Hospital, Sao Paulo, Brazil
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, Brussels 1070, Belgium
| |
Collapse
|
41
|
|
42
|
Evaluation of a model-based hemodynamic monitoring method in a porcine study of septic shock. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:505417. [PMID: 23585774 PMCID: PMC3621159 DOI: 10.1155/2013/505417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/22/2013] [Accepted: 02/06/2013] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The accuracy and clinical applicability of an improved model-based system for tracking hemodynamic changes is assessed in an animal study on septic shock. METHODS This study used cardiovascular measurements recorded during a porcine trial studying the efficacy of large-pore hemofiltration for treating septic shock. Four Pietrain pigs were instrumented and induced with septic shock. A subset of the measured data, representing clinically available measurements, was used to identify subject-specific cardiovascular models. These models were then validated against the remaining measurements. RESULTS The system accurately matched independent measures of left and right ventricle end diastolic volumes and maximum left and right ventricular pressures to percentage errors less than 20% (except for the 95th percentile error in maximum right ventricular pressure) and all R(2) > 0.76. An average decrease of 42% in systemic resistance, a main cardiovascular consequence of septic shock, was observed 120 minutes after the infusion of the endotoxin, consistent with experimentally measured trends. Moreover, modelled temporal trends in right ventricular end systolic elastance and afterload tracked changes in corresponding experimentally derived metrics. CONCLUSIONS These results demonstrate that this model-based method can monitor disease-dependent changes in preload, afterload, and contractility in porcine study of septic shock.
Collapse
|
43
|
Garcia Guerra G, Joffe AR, Senthilselvan A, Kutsogiannis DJ, Parshuram CS. Incidence of milrinone blood levels outside the therapeutic range and their relevance in children after cardiac surgery for congenital heart disease. Intensive Care Med 2013; 39:951-7. [PMID: 23435950 DOI: 10.1007/s00134-013-2858-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 01/21/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate whether variability in milrinone blood levels (MBL) occurs during administration to critically ill children after surgical repair of congenital heart disease, and the clinical relevance of this variability. METHODS Prospective cohort study conducted in the pediatric intensive care unit of a tertiary care teaching and referral hospital. MBL were measured at three time periods after starting milrinone infusion (9-12, 18-24, 40-48 h) and at the end of the infusion. MBL were categorized as within (100-300 ng/ml) or outside the therapeutic range. Low cardiac output syndrome was defined by elevation of either lactate (>2 mmol/l) or arteriovenous oxygen difference (>30%). Five other clinical outcomes were evaluated. Regression analyses evaluated the relationships between MBL and outcomes. RESULTS Sixty-three patients were included with a total of 220 MBL. Quantification of MBL was by high-performance liquid chromatography. Overall, 114 (52%) MBL were outside the therapeutic range: 78 (36%) subtherapeutic, and 36 (16%) supratherapeutic. Repeated-measures analysis found a significant association between supratherapeutic MBL and low cardiac output syndrome (p = 0.02), and supratherapeutic MBL were associated with arterial-central venous oxygen saturation difference >30% at time 3 (p = 0.007). CONCLUSIONS In this cohort, nontherapeutic MBL were common. Further investigation of milrinone dosing recommendations may improve the postoperative outcomes of children.
Collapse
Affiliation(s)
- Gonzalo Garcia Guerra
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada.
| | | | | | | | | |
Collapse
|
44
|
Lowry AW. Resuscitation and perioperative management of the high-risk single ventricle patient: first-stage palliation. CONGENIT HEART DIS 2013; 7:466-78. [PMID: 22985457 DOI: 10.1111/j.1747-0803.2012.00710.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Infants born with hypoplastic left heart syndrome or other lesions resulting in a single right ventricle face the highest risk of mortality among all forms of congenital heart disease. Before the modern era of surgical palliation, these conditions were universally lethal; recent refinements in surgical technique and perioperative management have translated into dramatic improvements in survival. Nonetheless, these infants remain at a high risk of morbidity and mortality, and an appreciation of single ventricle physiology is fundamental to the care of these high-risk patients. Herein, resuscitation and perioperative management of infants with hypoplastic left heart syndrome are reviewed. Basic neonatal and pediatric life support recommendations are summarized, and perioperative first-stage clinical management strategies are reviewed.
Collapse
Affiliation(s)
- Adam W Lowry
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| |
Collapse
|
45
|
Abstract
Cardiac output (CO) is the volume of blood pumped out by the heart in 1 minute. Monitoring of CO can guide therapy and improve clinical outcome in critically ill patients and during anesthesia. Although there is increasing research into clinically useful methods of monitoring CO in equine patients, there are limitations to the available methods. There are 4 basic methods of measuring CO: (1) indicator methods, (2) a derivation of the Fick principle, (3) arterial pulse wave analysis, and (4) imaging diagnostic techniques. This article discusses the importance of CO, available technology, and challenges of monitoring CO in equine medicine.
Collapse
Affiliation(s)
- Andre Shih
- Department of Large Animal Clinical Science, University of Florida College of Veterinary Medicine, 2015 Southwest 16th Avenue, Gainesville, FL 32610, USA.
| |
Collapse
|
46
|
Kang WS, Lee J, Shin H, Kim SH, Kim TY, Seo D, Yoon TG. Noninvasive Cardiac Output Monitoring in Paediatric Cardiac Surgery: Correlation between Change in Thoracic Fluid Content and Change in Patient Body Weight. J Int Med Res 2012; 40:2295-304. [DOI: 10.1177/030006051204000627] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Change in thoracic fluid content (TFC) derived via a bioreactance technique with a noninvasive cardiac output monitoring device (NICOM) reportedly shows a good correlation with the amount of fluid removed. The present study prospectively evaluated the utility and clinical application of TFC in the intraoperative fluid management of paediatric patients with congenital heart disease, undergoing cardiac surgery with bioreactance-based noninvasive monitoring. Methods: Haemodynamic parameters, patient body weight and parameters derived from the NICOM device (including cardiac output, cardiac index, TFC, percentage change in TFC compared with baseline [TFCd0%] and stroke volume variation) were recorded after anaesthesia induction but before surgical incision, and just before departure from the operating room to the intensive care unit. Results: In the 80 paediatric patients included in this study, linear regression analyses demonstrated good correlations between body weight gain and TFCd0%, between body weight gain % and TFCd0%, and between intra -operative fluid balance and TFCd0%. Conclusion: TFCd0% may be a useful indicator for intraoperative fluid management in paediatric patients with congenital heart disease, undergoing cardiac surgery.
Collapse
Affiliation(s)
- W-S Kang
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jh Lee
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hj Shin
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - S-H Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - T-Y Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dm Seo
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - T-G Yoon
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University Medical Centre, Konkuk University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
47
|
Vrancken S, de Boode W, Hopman J, Looijen-Salamon M, Liem K, van Heijst A. Influence of lung injury on cardiac output measurement using transpulmonary ultrasound dilution: a validation study in neonatal lambs. Br J Anaesth 2012; 109:870-8. [DOI: 10.1093/bja/aes297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
|
48
|
[Prognostic markers of mortality after congenital heart defect surgery]. An Pediatr (Barc) 2012; 77:366-73. [PMID: 22704907 DOI: 10.1016/j.anpedi.2012.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/15/2012] [Accepted: 03/21/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Our aim is to identify risk factors for mortality after surgery for congenital heart disease in children, in order to establish indications for extracorporeal membrane oxygenation (ECMO). PATIENTS AND METHODS One hundred and eighty six children underwent cardiac surgery with extracorporeal circulation from April 2007 to June 2009. The following parameters were measured serially during their stay in Paediatric Intensive Care (PICU): Arterial and venous blood pH, pCO2, base excess, oxygen saturation, arterio-venous oxygen saturation difference, oxygen extraction ratio, ventilatory dead space and intrapulmonary shunting. RESULTS Hospital mortality was 13,4%. The following risk factors for mortality were identified: age, bypass time, inotropic score, lactate level upon arrival in PICU including its peak value and its rate of variation, mixed venous saturation, base excess, ventilatory dead space, oxygen extraction ratio, and intrapulmonary shunting. However, the strongest predictors of mortality were bypass time, lactate levels upon admission on PICU, and the peak lactate level. Multivariate analysis showed a lactate level of 6.3mmol/l and a high blood lactate for 24hours to be independent predictors of mortality. CONCLUSIONS The peak lactate level is a strong predictor of mortality. As such, it would be a useful indicator of the need for ECMO support.
Collapse
|
49
|
Noninvasive assessment of myocardial function in sepsis. Pediatr Crit Care Med 2012; 13:362-3. [PMID: 22561267 DOI: 10.1097/pcc.0b013e31822f111c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
50
|
Chandler JR, Cooke E, Petersen C, Karlen W, Froese N, Lim J, Ansermino JM. Pulse oximeter plethysmograph variation and its relationship to the arterial waveform in mechanically ventilated children. J Clin Monit Comput 2012; 26:145-51. [DOI: 10.1007/s10877-012-9347-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/25/2012] [Indexed: 12/01/2022]
|