Validation of an Ultrasound Cardiac Output Monitor as a Bedside Tool for Pediatric Patients

Beltramo, Fernando; Menteer, Jondavid; Razavi, Asma; Khemani, Robinder G.; Szmuszkovicz, Jacqueline R.; Newth, Christopher J. L.; Ross, Patrick

doi:10.1007/s00246-015-1261-y

Cited by 31 publications

(24 citation statements)

References 27 publications

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“…9 Previous studies have validated the accuracy of this method and have shown that it is highly accurate against other standard hemodynamic assessment techniques; this technique has also been applied in many clinical applications with critical patients. 7 , 8 , 10 This noninvasive method is the most reasonable test for runners in both a pre- and postrace assessment setting.…”

Section: Methodsmentioning

confidence: 99%

“…The noninvasive ultrasonic flow measurement (USCOM; Sydney, Australia) is an advanced hemodynamic assessment method with reliable accuracy when compared to other standard methods and has been validated by many previous publications. 7 – 10 This is a noninvasive assessment which will not impair the performance of the runners before and after the race. This study was conducted to identify race predictors which could predict the race results and classify the runners allowing better safety management during the race and also to evaluate the physiologic effects of prolonged endurance physical exercise with a noninvasive flow assessment method.…”

Section: Introductionmentioning

confidence: 99%

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Race predictors and hemodynamic alteration after an ultra-trail marathon race

Taksaudom

Tongsiri

Potikul

et al. 2017

OAJSM

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ObjectiveUnique rough-terrain ultra-trail running races have increased in popularity. Concerns regarding the suitability of the candidates make it difficult for organizers to manage safety regulations. The purpose of this study was to identify possible race predictors and assess hemodynamic change after long endurance races.MethodsWe studied 228 runners who competed in a 66 km-trail running race. A questionnaire and noninvasive hemodynamic flow assessment including blood pressure, heart rate, stroke volume, stroke volume variation, systemic vascular resistance, cardiac index, and oxygen saturation were used to determine physiologic alterations and to identify finish predictors. One hundred and thirty volunteers completed the questionnaire, 126 participants had a prerace hemodynamic assessment, and 33 of these participants completed a postrace assessment after crossing the finish line. The participants were divided into a finisher group and a nonfinisher group.ResultsThe average age of all runners was 37 years (range of 24–56 years). Of the 228 runners, 163 (71.5%) were male. There were 189 (82.9%) finishers. Univariable analysis indicated that the finish predictors included male gender, longest distance ever run, faster running records, and lower diastolic pressure. Only a lower diastolic pressure was a significant predictor of race finishing (diastolic blood pressure 74–84 mmHg: adjusted odd ratio 3.81; 95% confidence interval [CI] =1.09–13.27 and diastolic blood pressure <74 mmHg: adjusted odd ratio 7.74; 95% CI =1.57–38.21) using the figure from the multivariable analysis. Among the finisher group, hemodynamic parameters showed statistically significant differences with lower systolic blood pressure (135.9±14.8 mmHg vs 119.7±11.3 mmHg; p<0.001), faster heart rate (72.6±10.7 bpm vs 96.4±10.4 bpm; p<0.001), lower stroke volume (43.2±13.6 mL vs 29.3±10.1 mL; p<0.001), higher stroke volume variation; median (interquartile range) (36% [25%–58%] vs 53% [33%–78%]; p<0.001), and lower oxygen saturation (97.4%±1.0% vs 96.4%±1.0%; p<0.001). Systemic vascular resistance and cardian index did not change significantly.ConclusionThe only race finishing predictor from the multivariable analysis was lower diastolic pressure. Finishers seem to have a hypovolemic physiologic response and a lower level of oxygen saturation.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Race predictors and hemodynamic alteration after an ultra-trail marathon race

Taksaudom

Tongsiri

Potikul

et al. 2017

OAJSM

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“…The use of a fluid responsiveness‐based resuscitative strategy for sepsis has recently been described in adults and awaits study in larger trials. The validation of several non‐invasive cardiac output monitors in children may pave the way for similar trials in a younger age group …”

Section: Fluid Volumementioning

confidence: 99%

Fluid resuscitation therapy for paediatric sepsis

Long

Duke

2016

J Paediatrics Child Health

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Sepsis and septic shock are the final common pathway for many decompensated paediatric infections. Fluid resuscitation therapy has been the cornerstone of haemodynamic resuscitation in these children. Good evidence for equivalence between 0.9% saline and 4% albumin, with the relative expense of the latter, has meant that 0.9% saline is currently the most commonly used resuscitation fluid world-wide. Evidence for harm from the chloride load in 0.9% saline has generated interest in balanced solutions as first line resuscitation fluids. Their safety has been well established in observational studies, and they may well be the most reasonable default fluid for resuscitation. Semi-synthetic colloids have been associated with renal dysfunction and death and should be avoided. There is evidence for harm from excessive administration of any resuscitation fluid. Resuscitation fluid volumes should be treated in the same way as the dose of any other intravenously administered medication, and the potential benefits versus harms for the individual patient weighed prior to administration.

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“…Concerning young patients, some authors claim children tend to have reliable USCOM measurements, as long as they are not critically ill or suffer from a structural heart disease [67,69]. A third study confirms this statement, yet reports a percentage error of 58% compared to TTE [70].…”

Section: Ultrasonic Cardiac Output Monitoringmentioning

confidence: 96%

Hemodynamic monitoring: To calibrate or not to calibrate? Part 2 — Non-calibrated techniques

Bernards¹,

Mekeirele²,

Hoffmann³

et al. 2015

Anaesthesiol Intensive Ther

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There is much evidence that fluid overload leads to adverse outcomes in perioperative and critically ill patients. Cardiac output monitoring can help us guiding initial and ongoing fluid resuscitation and can help us to assess whether a patient will be responsive to fluids when hypotensive. In recent years, many sophisticated devices that measure a variety of hemodynamic parameters have evolved on the market. We wanted to provide an overview of the different techniques available today, including their validation in different patient populations. In this second part of the review, we focus on non-calibrated techniques, both invasive and non-invasive. For each technique a short overview of the working principle, together with the advantages, disadvantages and the available validation literature is listed. Many promising minimal invasive monitoring devices can help us to further optimize our hemodynamic treatment in both the perioperative and critical care setting. However, the validation data are scarce for many of these techniques, especially in complex circumstances with changing hemodynamics (preload, afterload and contractility), as with the use of fluids and vasoactive medication. The measurements made by these devices, therefore, need to be interpreted with caution. Further improvements and more validation data are needed before these techniques can be implemented in common day practice. Moreover, in severely shocked hemodynamic unstable patients, calibrated techniques are to be preferred over those which are uncalibrated. Hence, the new techniques not only need to be accurate, but also need to be precise in order to keep track of changes.

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Validation of an Ultrasound Cardiac Output Monitor as a Bedside Tool for Pediatric Patients

Cited by 31 publications

References 27 publications

Race predictors and hemodynamic alteration after an ultra-trail marathon race

Race predictors and hemodynamic alteration after an ultra-trail marathon race

Fluid resuscitation therapy for paediatric sepsis

Hemodynamic monitoring: To calibrate or not to calibrate? Part 2 — Non-calibrated techniques

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