Hemodynamic Findings in Normal Children

Krovetz, L. Jerome; McLoughlin, Thomas G.; Mitchell, Max B.; Schiebler, Gerold L.

doi:10.1203/00006450-196703000-00006

Cited by 33 publications

(14 citation statements)

References 10 publications

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“…Furthermore, our baseline CI values correspond well with those obtained in normal children. The difference with CI values obtained by Krovetz is 0.08 (95%CI = −0.52‐0.68) L min −1 m −2 . At t2, all hemodynamic support had been stopped.…”

Section: Discussioncontrasting

confidence: 58%

Cardiac output‐guided hemodynamic therapy for adult living donor kidney transplantation in children under 20 kg: A pilot study

Voet

Nusmeier

Lerou

et al. 2019

Pediatric Anesthesia

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Background A living‐donor (adult) kidney transplantation in young children requires an increased cardiac output to maintain adequate perfusion of the relatively large kidney. To achieve this, protocols commonly advise liberal fluid administration guided by high target central venous pressure. Such therapy may lead to good renal outcomes, but the risk of tissue edema is substantial. Aims We aimed to evaluate the safety and feasibility of the transpulmonary thermodilution technique to measure cardiac output in pediatric recipients. The second aim was to evaluate whether a cardiac output‐guided hemodynamic therapy algorithm could induce less liberal fluid administration, while preserving good renal results and achieving increased target cardiac output and blood pressure. Methods In twelve consecutive recipients, cardiac output was measured with transpulmonary thermodilution (PiCCO device, Pulsion). The algorithm steered administration of fluids, norepinephrine and dobutamine. Hemodynamic values were obtained before, during and after transplantation. Results are given as mean (SD) [minimum‐maximum]. Results Age and weight of recipients was 3.2 (0.97) [1.6‐4.9] yr and 14.1 (2.4) [10.4‐18] kg, respectively. No complications related to cardiac output monitoring occurred. After transplantation, cardiac index increased with 31% (95% CI = 15%‐48%). Extravascular lung water and central venous pressure did not change. Fluids given decreased from 158 [124‐191] mL kg−1 in the first 2 patients to 80 (18) [44‐106] mL kg−1 in the last 10 patients. The latter amount was 23 mL kg−1 less (95% CI = 6‐40 mL kg−1) than in one recent study, but similar to that in another. After reperfusion, all patients received norepinephrine (maximum dose 0.45 (0.3) [0.1‐0.9] mcg kg−1 min−1). Patient and graft survivals were 100% with excellent kidney function at 6 months post‐transplantation. Conclusion Transpulmonary thermodilution‐cardiac output monitoring appeared to be safe and feasible. Using the cardiac output‐guided algorithm led to excellent renal results with a trend toward less fluids in favor of norepinephrine.

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Section: Discussioncontrasting

confidence: 58%

Cardiac output‐guided hemodynamic therapy for adult living donor kidney transplantation in children under 20 kg: A pilot study

Voet

Nusmeier

Lerou

et al. 2019

Pediatric Anesthesia

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“…The systolic pressure in children’s left ventricle generally remains below 110 mmHg while mean arterial pressure is around 80 mmHg in children circulation [67]. Reported right ventricular end-diastolic and systolic pressures are around 5 mmHg, 28 mmHg respectively and mean pulmonary arterial pressure can reach up to 22 mmHg being slightly lower with respect to those of adult cardiovascular system in the children around 9 years old [68]. The simulated pressures in the healthy child cardiovascular system were similar to those values reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Mathematical modeling of cardiac function to evaluate clinical cases in adults and children

Bozkurt

2019

PLoS ONE

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Time-varying elastance models can simulate only the pressure and volume signals in the heart chambers while the diagnosis of clinical cases and evaluation of different treatment techniques require more information. In this study, an extended model utilizing the geometric dimensions of the heart chambers was developed to describe the cardiac function. The new cardiac model was evaluated by simulating a healthy and dilated cardiomyopathy (DCM) condition for adults and children. The left ventricular ejection fraction, end-diastolic volume, end-diastolic diameter and diastolic sphericity index were 53.60%, 125 mL, 5.08 cm and 1.82 in the healthy adult cardiovascular system model and 23.70%, 173 mL, 6.60 cm and 1.40 in the DCM adult cardiovascular system model. In the healthy child cardiovascular system model, the left ventricular ejection fraction, end-diastolic volume, end-diastolic diameter and diastolic sphericity index were 59.70%, 92 mL, 4.10 cm and 2.26 respectively and 30.70%, 125 mL, 4.94 cm and 1.87 in the DCM child cardiovascular system model. The developed cardiovascular system model simulates the hemodynamic variables and clinical diagnostic indicators within the physiological range for healthy and DCM conditions proving the feasibility of this new model to evaluate clinical cases in adults and children.

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“…SVR was indexed to control for cohort body size differences and is low compared with published norms. 19,20 …”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Phenotype of the Failing Fontan in an Adult Population

Hebson

McCabe

Elder

et al. 2013

The American Journal of Cardiology

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Fontan failure can occur even with normal systolic ventricular function and often in the context of significant liver disease. We hypothesized that Fontan failure is hemodynamically distinct from traditional heart failure and characterized by low systemic vascular resistance (SVR) index and preserved cardiac index. Twenty-seven symptomatic adult Fontan (SAF) patients who underwent catheterization from 2001 to 2011 constituted our study group. Fifty-four predominantly asymptomatic pediatric Fontan (PF) patients who underwent catheterization during the same period were randomly selected to perform a control:case cohort analysis. Clinical comparisons were made between the 2 groups. The adults were more symptomatic than the PF cohort (New York Heart Association classes I and II or III and IV: 48% or 52% [SAF] vs 94% or 6% [PF], respectively, p <0.01). SAF versus PF mean catheterization findings were central venous pressure 18 ± 6 versus 14 ± 3 mm Hg (p <0.01), SVR index 1,680 ± 368 versus 1,960 ± 550 dyn s/cm5/m2 (p = 0.02), and cardiac index 2.7 ± 0.8 versus 2.8 ± 0.7 L/min/m2 (p = 0.25). By imaging, the SAF cohort demonstrated a greater incidence of abnormal liver texture changes (96% vs 75%, p = 0.04) and nodularity (77% vs 42%, p = 0.02). In conclusion, adult patients with failing Fontan circulation had a lower SVR index and similar cardiac index compared with the pediatric cohort. Liver disease in the adults was more advanced. Our data suggest that Fontan failure is a distinct circulatory derangement with hemodynamic features similar to portal hypertension, albeit with limited ability to augment cardiac output.

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Hemodynamic Findings in Normal Children

Cited by 33 publications

References 10 publications

Cardiac output‐guided hemodynamic therapy for adult living donor kidney transplantation in children under 20 kg: A pilot study

Cardiac output‐guided hemodynamic therapy for adult living donor kidney transplantation in children under 20 kg: A pilot study

Mathematical modeling of cardiac function to evaluate clinical cases in adults and children

Hemodynamic Phenotype of the Failing Fontan in an Adult Population

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