Thoracic Fluid Content (TFC) Measurement Using Impedance Cardiography Predicts Outcomes in Critically Ill Children

Sumbel, Lydia; Wats, Aanchal; Salameh, Mohammed; Appachi, Elumalai; Bhalala, Utpal

doi:10.3389/fped.2020.564902

Cited by 10 publications

(8 citation statements)

References 40 publications

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“…This is in agreement with Sumbel et al who found that TFC correlated with findings of pulmonary plethora on chest X-ray. 20 Our study showed that TFC at 24 hours of 24 mL/kg and TFC drop rate at 24 hours of >12% are significant discriminators of TTN from non-TTN, with the sensitivity of 97.1 and 47.1% and specificity 60 and 82.4% respectively. However, no significant difference in the fluid balance was detected between the two groups with RD.…”

Section: Discussionmentioning

confidence: 50%

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Thoracic Fluid Content in Neonates Presented with Respiratory Distress as a Predictive Tool for Transient Tachypnea of Newborn

2022

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Introduction Respiratory conditions are the most common reason for admission of newborns to a neonatal care unit. The index of contractility (ICON) can be used to measure the thoracic fluid content (TFC) in neonates which is a significant parameter in cases presented with transient tachypnea of newborn (TTN). Objective The objective was to compare TFC between newborn infants with TTN compared with other causes of respiratory distress (RD). We tested the hypothesis that TFC would be higher in infants with TTN. Study Design In total, 105 newborns were enrolled at the delivery room and were categorized into three groups: TTN, other causes of RD, and control, according to physical examination and Chest X-Ray. TFC was measured within the first 6 hours for all infants and at 24 and 48 hours for the first two groups. Results Demographic data showed higher male participants and use of antenatal steroid therapy in RD groups. TFC within the first 6 hours was higher in RD groups. However, TFC at 24 hours of ≤24 mL/kg, and TFC drop rate at 24 hours of >12% are statistically significant discriminators of TTN from non-TTN, with sensitivity and specificity of 97.1 and 47.1%, and 60 and 82.4%, respectively (Fig 1 and 2). Conclusion ICON can be used in conjunction with clinical parameters and CXR as a tool for differentiation between TTN and other causes of RD within the first 24 hours of life by using the cutoff value of TFC at 24 hours and TFC drop rate. This will allow earlier and optimum management of different causes of RD. Key Points

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Section: Discussionmentioning

confidence: 50%

“…This is in agreement with Sumbel et al who found that TFC correlated with findings of pulmonary plethora on chest X-ray. 20…”

Section: Discussionmentioning

confidence: 99%

Thoracic Fluid Content in Neonates Presented with Respiratory Distress as a Predictive Tool for Transient Tachypnea of Newborn

2022

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“…Thoracic intravascular and extravascular fluid content affect TFC values that are calculated from the thoracic electrical bioimpedance. Variations in TFC are known to reflect the total fluid changes [ 49 , 50 ]. In our study dogs, we find the TFC values closely follows the changes in the CO PATD such that they decrease with hemorrhage and normalize to baseline values after autologous blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Agreement between Electrical Cardiometry and Pulmonary Artery Thermodilution for Measuring Cardiac Output in Isoflurane-Anesthetized Dogs

Paranjape

Henao-Guerrero

Menciotti

et al. 2023

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In animals, invasive pulmonary artery thermodilution (PATD) is a gold standard for cardiac output (CO) monitoring, but it is impractical in clinical settings. This study evaluates the agreement between PATD and noninvasive electrical cardiometry (EC) for measuring CO and analyzes the other EC-derived hemodynamic variables in six healthy anesthetized dogs subjected to four different hemodynamic events in a sequential order: (1) euvolemia (baseline); (2) hemorrhage (33% blood volume loss); (3) autologous blood transfusion; and (4) 20 mL/kg colloid bolus. The CO measurements obtained using PATD and EC are compared using Bland–Altman analysis, Lin’s concordance correlation (LCC), and polar plot analysis. Values of p < 0.05 are considered significant. The EC measurements consistently underpredict the CO values as compared with PATD, and the LCC is 0.65. The EC’s performance is better during hemorrhage, thus indicating its capability in detecting absolute hypovolemia in clinical settings. Even though the percentage error exhibited by EC is 49.4%, which is higher than the standard (<30%), EC displays a good trending ability. Additionally, the EC-derived variables display a significant correlation with the CO measured using PATD. Noninvasive EC may have a potential in monitoring trends in hemodynamics in clinical settings.

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“…In our study, we observed a significant decrease in RR, MAP, SVR, and STR and an increase in TFC, while CO, CI, SV, and SI remained unchanged. TFC is a newer objective parameter that has shown to identify pulmonary congestion which might not be evident on chest x-rays ( 36 , 37 ). One study in critically ill children with respiratory failure and shock demonstrated that high TFC values correlate with pulmonary plethora and predicted patient outcomes ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department

et al. 2022

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IntroductionThe assessment of fluid responsiveness is important in the management of shock but conventional methods of assessing fluid responsiveness are often inaccurate. Our study aims to evaluate changes in objective hemodynamic parameters as measured using electrical cardiometry (ICON® monitor) following the fluid bolus in children presenting with shock and to evaluate whether any specific hemodynamic parameter can best predict fluid responsiveness among children with shock.Materials and MethodsWe conducted a prospective observational study in children presenting with shock to our emergency department between June 2020 and March 2021. We collected the parameters such as heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and hemodynamic data such as cardiac output CO), cardiac index (CI), index of contractility (ICON), stroke volume (SV), stroke index (SI), corrected flow time (FTC), systolic time ratio (STR), variation of index of contractility (VIC), stroke volume variation (SVV), systemic vascular resistance (SVR), and thoracic fluid content (TFC) using the ICON monitor before and after fluid bolus (FB). We assessed percent change (Δ) and used paired-sample Student’s t-test to compare pre- and post-hemodynamic data and Mann–Whitney U-test to compare fluid responders and non-responders. P-Values < 0.05 were considered statistically significant.ResultsWe recorded 42 fluid interventions in 40 patients during our study period. The median IQR age was 10.56 (4.8, 14.8) years with male/female ratio (1.2:1). There was a significant decrease in ΔRR [−1.61 (−14.8, 0); p = 0.012], ΔDBP [−5.5 (−14.4, 8); p = 0.027], ΔMAP [−2.2 (−11, 2); p = 0.018], ΔSVR [−5.8 (−20, 5.2); p = 0.025], and ΔSTR [−8.39 (−21, 3); p = 0.001] and significant increase in ΔTFC [6.2 (3.5, 11.4); p = 0.01] following FB. We defined fluid responders by an increase in SV by ≥10% after a single FB of 20 ml/kg crystalloid. Receiver operating curve analysis revealed that among all the parameters, 15% change in ICON had an excellent AUC (0.85) for the fluid responsiveness.ConclusionOur study showed significant changes in objective hemodynamic parameters, such as SVR, STR, and TFC following FB in children presenting with shock. A 15% change in ICON had an excellent predictive performance for the fluid responsiveness among our cohort of pediatric shock.

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Thoracic Fluid Content (TFC) Measurement Using Impedance Cardiography Predicts Outcomes in Critically Ill Children

Cited by 10 publications

References 40 publications

Thoracic Fluid Content in Neonates Presented with Respiratory Distress as a Predictive Tool for Transient Tachypnea of Newborn

Thoracic Fluid Content in Neonates Presented with Respiratory Distress as a Predictive Tool for Transient Tachypnea of Newborn

Agreement between Electrical Cardiometry and Pulmonary Artery Thermodilution for Measuring Cardiac Output in Isoflurane-Anesthetized Dogs

Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department

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