Measurement of systemic oxygen delivery and inotropy in healthy term neonates with the Ultrasonic Cardiac Output Monitor (USCOM)

He, Shijun; Sun, Xuegang; Zhang, Cheng; Zhuang, Jian; Sun, Yunxia; Zheng, Mingqi; Liu, Yumei; Madigan, Veronica; Smith, Brendan E.

doi:10.1016/j.earlhumdev.2012.10.006

Cited by 11 publications

(3 citation statements)

References 37 publications

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“…Whether this may explain the differences in cardiovascular parameters is still to be clarified. Our data are in line with a recently published paper which uses USCOM to compare a cohort of term newborns with low-birthweight newborn and very low birth weight newborns [15]. In this work, the authors show that parameters such as CO, SV and CI proportionally increase with birth weight, compatible with what we observed in our dataset for SGA and LGA ( Fig.…”

Section: Discussionsupporting

confidence: 93%

Evaluation of hemodynamics in healthy term neonates using ultrasonic cardiac output monitor

et al. 2020

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Background: Transition from intrauterine to extrauterine life is a critical phase during which several changes occur in cardiovascular system. In clinical practice, it is important to have a method that allows an easy, rapid and precise evaluation of hemodynamic status of a newborn for clinical management. We here propose a rapid, broadly applicable method to monitor cardiovascular function using ultrasonic cardiac output monitoring (USCOM). Methods: We here present data obtained from a cohort of healthy term newborns (n = 43) born by programmed cesarean section at Fondazione MBBM, Ospedale San Gerardo. Measurements were performed during the first hour of life, then at 6 + 2, at 12-24, and 48 h of life. We performed a screening echocardiography to identify a patent duct at 24 h and, if patent, it was repeated at 48 h of life. Results: We show that physiologically, during the first 48 h of life, blood pressure and systemic vascular resistance gradually increase, while there is a concomitant reduction in stroke volume, cardiac output, and cardiac index. The presence of patent ductus arteriosus significantly reduces cardiac output (p = 0.006) and stroke volume (p = 0.023). Furthermore, newborns born at 37 weeks of gestational age display significantly lower cardiac output (p < 0.001), cardiac index (p = 0.045) and stroke volume (p < 0.001) compared to newborns born at 38 and ≥ 39 weeks. Finally, birth-weight (whether adequate, small or large for gestational age) significantly affects blood pressure (p = 0.0349), stroke volume (p < 0.0001), cardiac output (p < 0.0001) and cardiac index (p = 0.0004). In particular, LGA infants display a transient increase in cardiac index, cardiac output and stroke volume up to 24 h of life; showing a different behavior from AGA and SGA infants. Conclusions: Compared to previous studies, we expanded measurements to longer time-points and we analyzed the impact of commonly used clinical variables on hemodynamics during transition phase thus making our data clinically applicable in daily routine. We calculate reference values for each population, which can be of clinical relevance for quick bedside evaluation in neonatal intensive care unit.

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Section: Discussionsupporting

confidence: 93%

Evaluation of hemodynamics in healthy term neonates using ultrasonic cardiac output monitor

et al. 2020

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“…Equally, from a prognostic viewpoint, knowledge of the normal range is required to establish goals of therapy. Reference ranges for haemodynamic parameters as measured by USCOM have been established for Chinese full-term neonates [16] , [17] , Chinese children aged 1 month–12 years [8] , Chinese and Caucasian adolescents aged between 12 and18 years [18] , and Chinese and Caucasian adults aged between 18 and 60 years (unpublished data). However, there are no reference ranges for the elderly, despite the increasing use of point of care haemodynamics in general, and the USCOM in particular, in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Age-specific non-invasive transcutaneous Doppler ultrasound derived haemodynamic reference ranges in elderly Chinese adults

et al. 2014

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BackgroundWhilst there is a presumption in medicine that ageing adversely affects cardiovascular function, it is unknown if resting haemodynamics are compromised in the elderly, and if so, to what degree. This study was intended to answer several questions; whether age-related changes in haemodynamics occur; whether there was a difference between the haemodynamics of ageing subjects with and without mild chronic disease; whether there was a difference in haemodynamics as measured from either the aortic or the pulmonary valve; and to establish reference ranges for this population.MethodsChinese adults aged over 60 years were divided into three age bands of 61–70, 71–80 and over 80 years. The haemodynamic parameters were measured using a non-invasive Doppler ultrasound-based instrument, the Ultrasonic Cardiac Output Monitor (USCOM).ResultsOne hundred and sixty-five subjects (48.5% males) were recruited. 78 (47.3%) had no known disease whilst 87 (52.7%) had mild chronic illness. A total of 21 individual haemodynamic parameters were measured or calculated for each subject. There were no significant differences in stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR) or in body surface area (BSA)-indexed parameters, SV index (SVI), cardiac index (CI) and SVR index (SVRI) across age groups, or in other indexed haemodynamic parameters. No significant differences in indexed haemodynamics were found between those subjects with and those without mild chronic disease. Small, statistically significant, but clinically insignificant, differences (< 5%) were found between the aortic and pulmonary valve measurements for SV, SVI and heart rate.ConclusionsAgeing does not have any significant effect on resting haemodynamics in the elderly population studied. Mild chronic disease does not adversely affect resting haemodynamics in this population.General SignificanceReference ranges were established for 21 haemodynamic parameters, as measured by USCOM, for an elderly Chinese population but not for non-Chinese populations.

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“…The expected normal values for global DO 2 I and global VO 2 I are 500 ml /min/m 2 , and 150 ml/min/m 2 respectively in adults ( 22 ). In the new born DO 2 I is high at birth reducing to a mean (SD) of 609 (141) ml/min/m 2 at 3 days of age ( 23 ). We noted that global DO 2 I above 600 ml/min/m 2 during the first 42 h of therapy in PICU was more likely to be associated with survival (Figure 2 ) in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Oxygen Delivery and Oxygen Consumption in Pediatric Fluid Refractory Septic Shock During the First 42 h of Therapy and Their Relationship to 28-Day Outcome

2018

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Background: In septic shock, both oxygen delivery (DO2) and oxygen consumption (VO2) are dysfunctional. The current therapeutic regimens are geared to normalize global oxygen delivery (DO2) to tissues via goal directed therapies but mortality remains high at 10–20%.Methods: We studied cardiac index (CI), systemic vascular resistance index (SVRI), central venous oxygen saturation (ScvO2), central venous pressure (CVP), peripheral oxygen saturation (SpO2), mean blood pressure (MBP), body temperature, blood lactate, base excess and hemoglobin concentration (Hb) in a cohort of children admitted in “fluid-refractory” severe septic shock to pediatric intensive care, over 4.5-years. We calculated their 6 h global oxygen delivery (DO2) and global oxygen consumption (VO2) over the first 42 h and looked at factors associated with VO2/DO2 ratio (i.e., global oxygen extraction, gO2ER) and 28-day mortality.Results: Sixty-two children mean age (SD) 7.19 (5.44) years were studied. Fifty-seven (93%) children were sedated and mechanically ventilated and all received adrenaline or noradrenaline or both and added milrinone in 6 (9.6%). At 28 days, 9 (14.5%) were dead. The global oxygen extraction ratio (gO2ER) was consistently lower amongst the survivors and independently predicted mortality (ROC AUC = 0.75). A lactate level of 4 mmol/l or above, when associated with a concurrent metabolic acidosis predicted mortality with a sensitivity of 100% (95% CI 90.5–100) and a specificity of 67.7% (95% CI 62.2–72.9). A gO2ER of 0.48 or above on admission to the PICU was associated with death with a 66.7% sensitivity (95%CI 29.9–92.5) and 90.5% specificity (95%CI 79.3–96.8). A global O2ER of >0.48 combined with a concurrent blood lactate >4.0 mmol/l at any time within the first 42 h of therapy predicted death with a sensitivity of 63.9% (95% CI, 46.2–79.1) and specificity of 97.8% (95% CI, 95.7–99.0). A radar plot identified MBP-CVP difference, and CI as additional goals of therapy that may offer a survival benefit.Conclusions: Global O2ER of >0.48 with a concurrent blood lactate >4.0 mmol/l in children with metabolic acidosis was an independent factor associated with death in fluid resistant septic shock. Trends of gO2ER seem useful to recognize survivors and non-survivors early in the illness.

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Measurement of systemic oxygen delivery and inotropy in healthy term neonates with the Ultrasonic Cardiac Output Monitor (USCOM)

Cited by 11 publications

References 37 publications

Evaluation of hemodynamics in healthy term neonates using ultrasonic cardiac output monitor

Evaluation of hemodynamics in healthy term neonates using ultrasonic cardiac output monitor

Age-specific non-invasive transcutaneous Doppler ultrasound derived haemodynamic reference ranges in elderly Chinese adults

Oxygen Delivery and Oxygen Consumption in Pediatric Fluid Refractory Septic Shock During the First 42 h of Therapy and Their Relationship to 28-Day Outcome

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