Repeated bedside echocardiography in children with respiratory failure

Abstract

BackgroundThe aim of this study was to verify the benefits and limitations of repeated bedside echocardiographic examinations in children during mechanical ventilation. For the purposes of this study, we selected the data of over a time period from 2006 to 2010.MethodsA total of 235 children, average age 3.21 (SD 1.32) years were included into the study and divided into etiopathogenic groups. High-risk groups comprised: Acute lung injury and acute respiratory distress syndrome (ALI/ARDS), return of spontaneous circulation after cardiopulmonary resuscitation (ROSC), bronchopulmonary dysplasia (BPD), cardiomyopathy (CMP) and cardiopulmonary disease (CPD). Transthoracic echocardiography was carried out during mechanical ventilation. The following data were collated for statistical evaluation: right and left ventricle myocardial performance indices (RV MPI; LV MPI), left ventricle shortening fraction (SF), cardiac output (CO), and the mitral valve ratio of peak velocity of early wave (E) to the peak velocity of active wave (A) as E/A ratio. The data was processed after a period of recovery, i.e. one hour after the introduction of invasive lines (time-1) and after 72 hours of comprehensive treatment (time-2). The overall development of parameters over time was compared within groups and between groups using the distribution-free Wilcoxons and two-way ANOVA tests.ResultsA total of 870 echocardiographic examinations were performed. At time-1 higher average values of RV MPI (0.34, SD 0.01 vs. 0.21, SD 0.01; p < 0.001) were found in all groups compared with reference values. Left ventricular load in the high-risk groups was expressed by a higher LV MPI (0.39, SD 0.13 vs. 0.29, SD 0.02; p < 0.01) and lower E/A ratio (0.95, SD 0.36 vs. 1.36, SD 0.64; p < 0.001), SF (0.37, SD 0.11 vs. 0.47, SD 0.02; p < 0.01) and CO (1.95, SD 0.37 vs. 2.94, SD 1.03; p < 0.01). At time-2 RV MPI were lower (0.25, SD 0.02 vs. 0.34, SD 0.01; p < 0.001), but remained higher compared with reference values (0.25, SD 0.02 vs. 0.21, SD 0.01; p < 0.05). Other parameters in high-risk groups were improved, but remained insignificantly different compared with reference values.ConclusionEchocardiography complements standard monitoring of valuable information regarding cardiac load in real time. Chest excursion during mechanical ventilation does not reduce the quality of the acquired data.

Clinical impact and efficacy of bedside echocardiography on patient management in pediatric intensive care units (PICUs): A prospective study

“…Stanko and coauthors reported that TTE resulted in a change in the diagnosis and management frequently ( 25 ). According to Kobr et al ( 26 ), repeated bedside echocardiography was a useful addition to the inclusive hemodynamic monitoring of critically ill children because it complements standard monitoring about the cardiac status. Some studies confirm that the monitoring of changes in myocardial performance indexes provides valuable information ( 26 – 29 ) and their methodology can be performed by a trained intensivist ( 26 ).…”

Pulmonary Hypertension and Vascular Abnormalities in Bronchopulmonary Dysplasia

“…64 Another study demonstrated that respiratory failure requiring mechanical ventilation from multiple etiologies, including BPD, was associated with significantly increased right ventricular MPI compared to controls, 65 suggesting that MPI may be a surrogate for worse respiratory disease. Further studies are needed to determine whether high right ventricular MPI is associated with BPD and/or PH.…”

Monitoring of Children With Pediatric Acute Respiratory Distress Syndrome

“…A study reporting 103 examinations conducted in children with PARDS confirmed its feasibility (89). It is a discontinuous, but noninvasive, technology.…”