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Francisco MJ, de Lira EB, de Queiroz MRG. Point-of-Care in Clinical Practice: Consolidated Reality. Arq Bras Cardiol 2024; 121:e20230688. [PMID: 38451562 PMCID: PMC11081179 DOI: 10.36660/abc.20230688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 03/08/2024] Open
Affiliation(s)
- Miguel José Francisco
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Albert EinsteinSão PauloSPBrasilFaculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP – Brasil
| | - Edgar Bezerra de Lira
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Albert EinsteinSão PauloSPBrasilFaculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP – Brasil
| | - Marcos Roberto Gomes de Queiroz
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Albert EinsteinSão PauloSPBrasilFaculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP – Brasil
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2
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Le LS, Kinsella JP, Gien J, Frank BS. Failure to Normalize Biventricular Function Is Associated with Extracorporeal Membrane Oxygenation Use in Neonates with Congenital Diaphragmatic Hernia. J Pediatr 2023; 260:113490. [PMID: 37201678 DOI: 10.1016/j.jpeds.2023.113490] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
We examined postnatal echocardiograms for 62 infants with congenital diaphragmatic hernia born from 2014 through 2020. Left and right ventricular dysfunction on D0 were sensitive, whereas persistent dysfunction on D2 was specific for extracorporeal membrane oxygenation requirement. Biventricular dysfunction had the strongest association with extracorporeal membrane oxygenation. Serial echocardiography may inform prognosis in congenital diaphragmatic hernia.
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Affiliation(s)
- Lisa S Le
- Heart Institute, Children's Hospital Colorado, Aurora CO
| | - John P Kinsella
- Department of Pediatrics Section of Neonatology, University of Colorado, Aurora CO
| | - Jason Gien
- Department of Pediatrics Section of Neonatology, University of Colorado, Aurora CO
| | - Benjamin S Frank
- Department of Pediatrics Section of Cardiology, University of Colorado, Aurora CO.
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3
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Persson JN, Kim JS, Good RJ. Diagnostic Utility of Point-of-Care Ultrasound in the Pediatric Cardiac Intensive Care Unit. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2022; 8:151-173. [PMID: 36277259 PMCID: PMC9264295 DOI: 10.1007/s40746-022-00250-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 12/26/2022]
Abstract
Purpose of Review Recent Findings Summary Supplementary Information
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Affiliation(s)
- Jessica N. Persson
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
- Division of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
| | - John S. Kim
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
| | - Ryan J. Good
- Division of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
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Zekri H, Said RN, Hegazy RA, Darwish RK, Kamel A, El Hakim NGA. B-type Natriuretic Peptide: A Diagnostic Biomarker for a Hemodynamically Significant PDA. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: B-type natriuretic peptide (BNP) it has been reported to be a useful biomarker for the severity of hemodynamically significant patent ductus arteriosus (HsPDA) in premature infants. Objective: To assess serum levels of BNP in premature neonates with echocardiographically-confirmed hemodynamically significant and non-significant PDA (HnsPDA) and to explore the effect of PDA on left ventricular function. We also aimed to detect the level of BNP that differentiates between HsPDA and HnsPDA. Patients and methods: This was a cross-sectional observational study conducted on 73 randomly selected preterm neonates with HsPDA or hemodynamically nonsignificant PDA (HnsPDA), between May 2017 and May 2018. Echocardiography was done. BNP was measured using enzyme linked immunosorbent assay Results: There was no affection of left ventricular function in either group (LA/Ao ratio, FS, LVESD and LVEDD). PDA size, PFO size and PAP were significantly larger in HsPDA (p<0.001, p=0.001, p<0.001 respectively). Levels of BNP were significantly higher in HsPDA and correlated with the size of the PDA. At a cut-off value of 160.5 pg/ml, BNP had 80.49% sensitivity and 90.62% specificity with a positive predictive value of 91.7% and a negative predictive value of 78.04%, (AUC: 0.923, 95% C.I. 0.837 to 0.973). Conclusion: Levels of BNP in preterm babies with hemodynamically significant PDA rise early in neonatal life and correlate well with the size of the PDA. BNP can be used to screen for this condition. Ventricular dysfunction may not appear in the first 3 days of life.
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5
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Lorimer D, Spies R, Chokshi R, Lee CK, Colombo JN. Common indications and impact on clinical management of overnight, inpatient transthoracic echocardiograms performed by pediatric cardiology fellows. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101514] [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: 10/18/2022]
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6
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Zhong J, Shuai C, Wang Y, Mo J, Ma D, Zhang J, Lin Y, Yang J, Ye X. Baseline Values of Left Ventricular Systolic Function in Preterm Infants With Septic Shock: A Prospective Observational Study. Front Pediatr 2022; 10:839057. [PMID: 35425723 PMCID: PMC9001981 DOI: 10.3389/fped.2022.839057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIM Guidelines recommended that cardiac index (CI) of term infants with septic shock should reach the target level of 3.3-6.0L/(min⋅m2). However, there are still no standard values for preterm infants with septic shock. Herein, we investigated the functional echocardiographic baseline values of left ventricular (LV) systolic functional parameters at the onset of septic shock in preterm infants and possible correlations between baseline values and poor outcomes. MATERIALS AND METHODS This was a prospective, observational, and longitudinal single-center study. Eligible infants were monitored for LV systolic functional parameters using functional echocardiography at the onset of septic shock. The primary study outcome was the difference in the baseline value of LV systolic functional parameters in preterm infants with septic shock with different gestational age (GA) and birth weight (BW). The secondary outcome was septic shock-associated death or severe brain injury (including grade 3-4 intraventricular hemorrhage or periventricular leukomalacia). RESULTS In total, 43 subjects met the criteria, with a median GA of 321/7 weeks and BW of 1800 grams. No difference was observed in baseline values of LV systolic functional parameters among infants with different GA and BW. Infants were assigned to good and poor outcomes groups based on septic shock-associated death or severe brain injury. Out of 43 infants, 29 (67.4%) had good outcomes vs. 14 (32.6%) with poor outcomes. Stroke index (SI) [18.2 (11.1, 18.9) mL/m2 vs. 23.5 (18.9, 25.8) mL/m2, p = 0.017] and cardiac index (CI)[2.7 (1.6, 3.5) L/(min⋅m2) vs. 3.4 (3.0, 4.8) L/(min⋅m2), p = 0.015] in infants with poor outcomes were significantly lower (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the cut-off values of SI and CI for predicting poor outcomes in preterm infants with septic shock were 19.5 mL/m2 (sensitivity, 73.9%; specificity, 81.8%) and 2.9L/(min⋅m2) (sensitivity, 78.3%; specificity, 72.7%), with area under the ROC curve (AUC) value of 0.755 and 0.759, respectively. CONCLUSION There were no differences in baseline LV systolic functional values among preterm infants with septic shock with different GA and BW. However, preterm infants with SI<19.5mL/m2 and/or CI<2.9L/(min⋅m2) at the onset of septic shock were at high risk of having poor outcomes.
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Affiliation(s)
- Junjuan Zhong
- Neonatal Intensive Care Unit, Guangdong Women's and Children's Hospital, Guangzhou, China
| | - Chun Shuai
- Neonatal Intensive Care Unit, Guangdong Women's and Children's Hospital, Guangzhou, China
| | - Yue Wang
- Neonatal Intensive Care Unit, Guangdong Women's and Children's Hospital, Guangzhou, China
| | - Jing Mo
- Neonatal Intensive Care Unit, Guangdong Women's and Children's Hospital, Guangzhou, China
| | - Dongju Ma
- Neonatal Intensive Care Unit, Guangdong Women's and Children's Hospital, Guangzhou, China
| | - Jing Zhang
- Neonatal Intensive Care Unit, Guangdong Women's and Children's Hospital, Guangzhou, China
| | - Yingyi Lin
- Neonatal Intensive Care Unit, Guangdong Women's and Children's Hospital, Guangzhou, China
| | - Jie Yang
- Neonatal Intensive Care Unit, Guangdong Women's and Children's Hospital, Guangzhou, China
| | - Xiuzhen Ye
- Neonatal Intensive Care Unit, Guangdong Women's and Children's Hospital, Guangzhou, China
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7
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Yildizdas D, Aslan N. A trend skill that makes pediatric intensivists stand out: Critical care echocardiography. Australas J Ultrasound Med 2021; 24:78-81. [PMID: 34765414 DOI: 10.1002/ajum.12233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Recently, the use of point-of-care ultrasonography (POCUS) by pediatricians especially in emergency and intensive care departments has become increasingly popular. Critical care echocardiography (CCE) quickly and accurately identifies cardiac function, allowing intensivists to manage critically ill pediatric patients by manipulating vasoactive-inotrope-fluid treatment based on the echocardiographic results. Training courses for POCUS are increasingly available and more intensivists are learning how to use CCE. In this review, we focus on the importance and utility of CCE in pediatric intensive units and how it assists in the management of hemodynamically unstable pediatric patients. We highlight the common measurements carried out by intensive care specialists and emphasize the role of the CCE methods in PICUs.
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Affiliation(s)
- Dincer Yildizdas
- Department of Pediatric Intensive Care Cukurova University Faculty of Medicine Adana Turkey
| | - Nagehan Aslan
- Department of Pediatric Intensive Care Cukurova University Faculty of Medicine Adana Turkey
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8
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Watkins LA, Dial SP, Koenig SJ, Kurepa DN, Mayo PH. The Utility of Point-of-Care Ultrasound in the Pediatric Intensive Care Unit. J Intensive Care Med 2021; 37:1029-1036. [PMID: 34632837 DOI: 10.1177/08850666211047824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: Point of care ultrasound (POCUS) in adult critical care environments has become the standard of care in many hospitals. A robust literature shows its benefits for both diagnosis and delivery of care. The utility of POCUS in the pediatric intensive care unit (PICU), however, is understudied. This study describes in a series of PICU patients the clinical indications, protocols, findings and impact of pediatric POCUS on clinical management. Design: Retrospective analysis of 200 consecutive POCUS scans performed by a PICU physician. Patients: Pediatric critical care patients who required POCUS scans over a 15-month period. Setting: The pediatric and cardiac ICUs at a tertiary pediatric care center. Interventions: Performance of a POCUS scan by a pediatric critical care attending with advanced training in ultrasonography. Measurement and Main Results: A total of 200 POCUS scans comprised of one or more protocols (lung and pleura, cardiac, abdominal, or vascular diagnostic protocols) were performed on 155 patients over a 15-month period. The protocols used for each scan reflected the clinical question to be answered. These 200 scans included 133 thoracic protocols, 110 cardiac protocols, 77 abdominal protocols, and 4 vascular protocols. In this series, 42% of scans identified pathology that required a change in therapy, 26% confirmed pathology consistent with the ongoing plans for new therapy, and 32% identified pathology that did not result in initiation of a new therapy. Conclusions: POCUS performed by a trained pediatric intensivist provided useful clinical information to guide patient management.
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Affiliation(s)
- Laura A Watkins
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- 6923Present Affiliation: University of Rochester, Rochester, NY, USA
| | - Sharon P Dial
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Seth J Koenig
- 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dalibor N Kurepa
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Paul H Mayo
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- 5799Northwell LIJ/NSUH Hospital, New Hyde Park, NY, USA
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9
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Kurath-Koller S, Koestenberger M, Hansmann G, Cantinotti M, Tissot C, Sallmon H. Subcostal Echocardiographic Imaging in Neonatal and Pediatric Intensive Care. Front Pediatr 2021; 9:471558. [PMID: 34249801 PMCID: PMC8264136 DOI: 10.3389/fped.2021.471558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hanover, Germany
| | - Massimiliano Cantinotti
- Fondazione Consiglio Nazionale delle Ricerche Area (CNR)-Regione Toscana G. Monasterio (FTGM), Pisa, Italy
| | - Cecille Tissot
- Center de Pediatrie, Clinique des Grangettes, Chêne-Bougeries, Switzerland
| | - Hannes Sallmon
- Department of Pediatric Cardiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
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10
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Haroon-Mowahed Y, Cheen Ng S, Barnett S, West S. Ultrasound in paediatric anaesthesia - A comprehensive review. ULTRASOUND (LEEDS, ENGLAND) 2021; 29:112-122. [PMID: 33995558 PMCID: PMC8083139 DOI: 10.1177/1742271x20939260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
The use of ultrasound is becoming more widespread in anaesthesia. In this review, we discuss the use of ultrasound in various aspects of paediatric anaesthesia and how it can be used to assist diagnostic and therapeutic interventions and the evidence available. We explore the use of ultrasound as an adjunct for regional anaesthesia, vascular access, airway management, bedside cardiac, pulmonary and abdominal imaging and intracranial pressure monitoring.
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Affiliation(s)
- Yumna Haroon-Mowahed
- Department of Anaesthetics, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London UK
| | - Su Cheen Ng
- Department of Anaesthetics, University College Hospital, London, UK
| | - Sarah Barnett
- Department of Anaesthetics, University College Hospital, London, UK
| | - Simeon West
- Department of Anaesthetics, University College Hospital, London, UK
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11
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A new stethoscope for pediatric intensivists: Point-of-care ultrasound. Turk Arch Pediatr 2021; 55:345-353. [PMID: 33414651 PMCID: PMC7750349 DOI: 10.14744/turkpediatriars.2020.12499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022]
Abstract
In recent years, the use of point-of-care ultrasound by non-radiologist physicians has become widespread. Especially for clinicians working in pediatric emergency departments and pediatric intensive care units, point-of-care ultrasound has almost become a part of physical examinations due to the rapid responses it offers to the problems of critically ill patients. Numerous studies revealed the important clinical benefits of point-of-care ultrasound use by pediatric intensive care providers. In this review, we aimed to give detailed information about different types of point-of-care ultrasound applications in pediatric intensive care units and wanted to draw attention to the increased use and clinical benefits of this noninvasive and radiation free technique.
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12
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Phad N, de Waal K. Left ventricular ejection fraction using manual and semi-automated biplane method of discs in very preterm infants. Echocardiography 2020; 37:1265-1271. [PMID: 32618392 DOI: 10.1111/echo.14784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Biplane left ventricular ejection fraction (LVEF) is a valuable echocardiographic parameter for assessment of LV systolic pump efficiency in adults and children, but not often reported in preterm infants. The primary aim of this study was to longitudinally measure biplane LVEF in very preterm infants during the neonatal intensive care period. Secondary aim was to compare manual and semi-automatic determination of LVEF for agreement and variability. METHODS Stable preterm infants less than 30 weeks gestation were scanned on day 3, day 28, and at 36 weeks postmenstrual age. The LV endocardium was traced manually and semi-automatically using integrated speckle tracking software in apical 4-chamber and apical 3-chamber images to obtain end-diastolic volume and end-systolic volume, and calculate LVEF. Agreement between methods and variability within and between observers was determined using an interclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS Sixty-six preterm infants with a mean birth weight of 1100 (239) g were analyzed. The average manual biplane LVEF was 58 (3)%, 59 (3)%, and 55 (4)% at the three respective time points. Manual LVEF showed good agreement with semi-automatic LVEF (ICC 0.76) with a small bias of -1.5 (3.0)%. Interobserver variability of LVEF improved with semi-automatic tracing of the LV endocardial border (ICC manual 0.68 vs semi-automatic 0.80). CONCLUSION Left ventricular systolic pump efficiency in preterm infants remains stable during the neonatal intensive care period. Semi-automatic biplane LVEF has less interobserver variability and can be used interchangeably with manual biplane LVEF.
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Affiliation(s)
- Nilkant Phad
- John Hunter Children's Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Koert de Waal
- John Hunter Children's Hospital, University of Newcastle, Newcastle, NSW, Australia
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13
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Jangam SS, Lakshmi S, Jayashree M, Rekha S, Nakul P. Point-of-care ultrasound in pediatric cardiac masses: A case series. JOURNAL OF PEDIATRIC CRITICAL CARE 2020. [DOI: 10.4103/jpcc.jpcc_61_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Acheampong B, Parra DA, Aliyu MH, Moon TD, Soslow JH. Smartphone interfaced handheld echocardiography for focused assessment of ventricular function and structure in children: A pilot study. Echocardiography 2019; 37:96-103. [PMID: 31879998 DOI: 10.1111/echo.14575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Miniaturized echocardiographic machines improve availability and portability and can be particularly useful for underserved and resource-limited settings. The goal of this study was to compare left ventricular fractional shortening (FS) and left ventricular ejection fraction (LVEF) obtained by a newer handheld echo (HHE) machine to standard transthoracic echocardiogram (TTE) in children. METHODS Pediatric outpatients (Birth-18 years) undergoing TTE were prospectively enrolled. HHE protocol included 2D and M-mode images from the parasternal long, short, and apical-4 chamber views. HHE and TTE measurements were reviewed for agreement. Kappa statistic was used to analyze qualitative indices while FS and LVEF were analyzed with Lin's concordance correlation coefficient (CCC) and Bland-Altman limits of agreement (loa). RESULTS Sixty children were enrolled; 55 were included in the quantitative analysis. Mean age was 7.5 ± 5.5 years; 67% males; median HHE image acquisition duration was 2.3(1-5) minutes. Fractional shortening and EF by HHE showed good agreement with TTE [CCC = 0.82, 95%CI (0.73,0.90), mean bias -3.18%, loa (-7.00,6.44%) vs CCC = 0.81 (0.72,0.90), mean bias -0.87%, loa (-6.94,5.17%], respectively. In children ≤5 years, HHE FS (n = 20) and EF (n = 21) agreed with TTE measurement [0.59 (0.31, 0.88), mean bias 0.30%, loa (-8.5, 9.1%); 0.79 (0.63, 0.96), mean bias 0.10%, loa (-5.99, 6.14)]. Kappa values for RV size, function, and LV function were 1.00 (P < .05); 0.75 for LV size (P < .05) and 0.66 for pericardial effusion (P < .05). CONCLUSION Handheld echo demonstrates good correlation with standard TTE for focused assessment of ventricular chamber sizes and function in children.
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Affiliation(s)
- Benjamin Acheampong
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Troy D Moon
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan H Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
Maintaining optimal circulatory status is a key component of preterm neonatal care. Low-cardiac output (CO) in the preterm neonate leads to inadequate perfusion of vital organs and has been linked to a variety of adverse outcomes with heightened acute morbidity and mortality and adverse neurodevelopmental outcomes. Having technology available to monitor CO allows us to detect low-output states and potentially intervene to mitigate the unwanted effects of reduced organ perfusion. There are many technologies available for the monitoring of CO in the preterm neonatal population and while many act as useful adjuncts to aid clinical decision-making no technique is perfect. In this review, we discuss the relative merits and limitations of various common methodologies available for monitoring CO in the preterm neonatal population. We will discuss the ongoing challenges in monitoring CO in the preterm neonate along with current gaps in our knowledge. We conclude by discussing emerging technologies and areas that warrant further study.
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Affiliation(s)
- Matthew McGovern
- Neonatology Department, Coombe Women and Infant University Hospital, Dublin, Ireland.,Department of Paediatrics, Trinity College Dublin, National Children's Hospital Tallaght, Dublin, Ireland
| | - Jan Miletin
- Neonatology Department, Coombe Women and Infant University Hospital, Dublin, Ireland.,Institute for the Care of Mother and Child, Prague, Czechia.,3rd School of Medicine, Charles University, Prague, Czechia.,UCD School of Medicine and Medical Sciences, Dublin, Ireland
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