Non-invasive cardiac output and oxygen delivery measurement in an infant with critical anemia

Steil, Garry M.; Eckstein, Olive S.; Caplow, Julie; Agus, Michael S. D.; Walsh, Brian K; Wong, Jackson

doi:10.1007/s10877-011-9287-z

Cited by 8 publications

(3 citation statements)

References 36 publications

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“…We have presented a comprehensive account of the cardiovascular parameters in a cohort of children in “fluid resistant” septic shock during the first 42 h of bundle therapy in intensive care. Their severity of illness is indicated by the PIM2 scores ( 20 ). The titration of inotropes and vasopressors during treatment was assisted by non-invasive 6 hourly cardiac output monitoring.…”

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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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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“…This device estimates CO, CI, stroke volume (SV), SI, and a variety of other cardiac parameters using a complex mathematical algorithm (electrical velocimetry relates the maximum rate of change of impedance to peak aortic blood acceleration during the cardiac cycle) with the simple application of four EKG electrodes . The accuracy of this monitor has been validated and compared with other measures of CO such as the Fick equation , thermodilution , and echocardiography in diverse pediatric populations including patients with congenital heart disease and critical illness , neonates , and obese adolescents . One study of patients who had recovered from critical illness demonstrated a bias toward underestimation of CI and another found it to be useful in patients who had undergone cardiac surgery .…”

Section: Discussionmentioning

confidence: 99%

Continuous noninvasive cardiac output in children: is this the next generation of operating room monitors? Initial experience in 402 pediatric patients

Coté

Sui

Anderson

et al. 2014

Pediatric Anesthesia

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Summary Background Electrical Cardiometry™ (EC) estimates cardiac parameters by measuring changes in thoracic electrical bioimpedance during the cardiac cycle. The ICON®, using four electrocardiogram electrodes (EKG), estimates the maximum rate of change of impedance to peak aortic blood acceleration (based on the premise that red blood cells change from random orientation during diastole (high impedance) to an aligned state during systole (low impedance)). Objective To determine whether continuous cardiac output (CO) data provide additional information to current anesthesia monitors that is useful to practitioners. Methods After IRB approval and verbal consent, 402 children were enrolled. Data were uploaded to our anesthesia record at one‐minute intervals. Ten‐second measurements (averaged over the previous 20 heart beats) were downloaded to separate files for later comparison with routine OR monitors. Results Data from 374 were in the final cohort (loss of signal or improper lead placement); 292 012 measurements during 58 049 min of anesthesia were made in these children (1 day to 19 years and 1 to 107 kg). Four events had a ≥25% reduction in cardiac index at least 1 min before a clinically important change in other monitored parameters; 18 events in 14 children confirmed manifestations of other hemodynamic measures; eight events may have represented artifacts because the observed measurements did not seem to fit the clinical parameters of the other monitors; three other events documented decreased stroke index with extreme tachycardia. Conclusions Electrical cardiometry provides real‐time cardiovascular information regarding developing hemodynamic events and successfully tracked the rapid response to interventions in children of all sizes. Intervention decisions must be based on the combined data from all monitors and the clinical situation. Our experience suggests that this type of monitor may be an important addition to real‐time hemodynamic monitoring.

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“…Infants with RSV bronchiolitis represent an ideal population for use of this non-invasive CO monitoring device, which can offer an adjunct hemodynamic measure to HR and blood pressure in infants who may require referral to subspecialty units and/or tertiary care facilities for worsening clinical status. In infants with RSV bronchiolitis, the EC monitor is one of only a few methods that have been demonstrated to measure CO continuously [38] and non-invasively. CO monitoring in infants remains a clinical challenge [39,40].…”

Section: Discussionmentioning

confidence: 99%

Changes in cardiac output and stroke volume as measured by non-invasive CO monitoring in infants with RSV bronchiolitis

Caplow

McBride

Steil

et al. 2012

J Clin Monit Comput

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Non-invasive cardiac output and oxygen delivery measurement in an infant with critical anemia

Abstract: Non-invasive continuous CO and CaO(2) monitors are shown in this single case to provide continuous DO(2) measurement. The ability to assess DO(2) may improve hemodynamic monitoring during goal directed therapies.

Cited by 8 publications

References 36 publications

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

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

Continuous noninvasive cardiac output in children: is this the next generation of operating room monitors? Initial experience in 402 pediatric patients

Changes in cardiac output and stroke volume as measured by non-invasive CO monitoring in infants with RSV bronchiolitis

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