Articles

The Value of Noninvasive Continuous Cardiac Output Monitoring in Assessment of Hemodynamic Status in Critically Ill Children

Abstract

Access to reliable, rapid, and continuous hemodynamic monitoring parameters is essential for early diagnosis and prompt treatment of hemodynamic disorders in critically ill children. The aim of this observational study was to compare the accuracy of continuous non-invasive cardiac output monitoring (NICCOMO) device data with transthoracic echocardiography (TTE) and inferior vena cava (IVC) ultrasound findings in assessing cardiac output (C.I), circulatory fluid adequacy, and finally Determination of hemodynamic status in patients with Critical conditions hospitalized in the Pediatric Intensive Care Unit (PICU). In this observational study, forty-four critically ill children that were admitted to PICU were evaluated. We used NICCOMO, TTE, and IVC ultrasonography at the same time in critical patients. The association between NICCOMO parameters and echocardiogram cardiac index and IVC quality in ultrasound is compared. The agreement between CI measured by TTE and NICCOMO was assessed using the Bland-Altman analysis method. NICCOMO is not a reliable instrument for determining CI in children with an unstable hemodynamic status. However, the parameters of this device are reliable in assessing the patient's hemodynamic status. Findings showed that 90% of patients in the normal hemodynamic state in NICCOMO have SVR. I in the normal range (P<0.001), and all cases in hypervolemic state had volume overload IVC in ultrasonography analysis. Noninvasive continuous cardiac output monitoring could be used to estimate unstable patients’ hemodynamic status in the initial stages for making timely treatment-related decisions, but its use for accurate cardiac index measurement is not reliable in all cases.

 

1.Fitzgerald JC, Weiss SL, Kissoon N. Rogers’ Textbook of Pediatric Intensive Care: Recognition and Initial Management of Shock: the 2016 update. WFPICCS J 2016; 17: 1120.
2.Davis AL, Carcillo JA, Aneja RK, Deymann AJ,et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit care med 2017; 45:1061-1093.
3.Long E, Oakley E, Babl FE, Duke T; Paediatric Research in Emergency Departments International Collaborative (PREDICT). An observational study using ultrasound to assess physiological changes following fluid bolus administration in paediatric sepsis in the emergency department. BMC Pediatr. 2016;16:93
4.Stricker PA, Lin EE, Fiadjoe JE,et al. Evaluation of central venous pressure monitoring in children undergoing craniofacial reconstruction surgery. Anesth Analg 2013;116:411-419.
5. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness?: A systematic review of the literature and the tale of seven mares. Chest 2008; 134:172-178.
6. Sasai T, Tokioka H, Fukushima T, et al. Reliability of central venous pressure to assess left ventricular preload for fluid resuscitation in patients with septic shock. J Intensive Care2014; 2:1-7.
7. Johansson E, Hammarskjöld F, Lundberg D, Arnlind MH. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: a systematic review of the literature. Acta Oncol2013; 52:886-892.
8. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med2012; 41:580-637.
9. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit care med2011; 39:259-265.
10. Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med 2012; 13:253-258.
11. Klugman D, Berger JT. Echocardiography as a hemodynamic monitor in critically ill children. Pediatr Crit Care Med2011; 12: 50-54.
12. Singh Y. Echocardiographic evaluation of hemodynamics in neonates and children. Front Pediatr 2017; 15:201.
13. Vaish H, Kumar V, Anand R, Chhapola V, Kanwal SK. The correlation between inferior vena cava diameter measured by ultrasonography and central venous pressure. Indian J Pediatr 2017; 84:757-562.
14. Bradley P. Fuhrman, Jerry J. Zimmerman. Textbook of Pediatric Critical Care.Elsevier 2016 ; CHAPTER 36, BOX 36.7
15. Cattermole GN, Leung PM, Ho GY, et al. The normal ranges of cardiovascular parameters measured using the ultrasonic cardiac output monitor. Physiol Rep 2017;5.
16. Chaiyakulsil C, Chantra M, Katanyuwong P, Khositseth A, Anantasit N. Comparison of three non-invasive hemodynamic monitoring methods in critically ill children. PLoS One2018; 13.
17. Lai WW, Geva T, Shirali GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2006; 19:1413-1430.
18. Keren H, Burkhoff D, Squara P. Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance. Am J Physiol Heart Circ Physiol2007;293(1).
19. Raval NY, Squara P, Cleman M, Yalamanchili K, Winklmaier M, Burkhoff D. Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique. J Clin Monit Comput 2008; 22:113-119.
20. Squara P, Denjean D, Estagnasie P, Brusset A, Dib JC, Dubois C. Noninvasive cardiac output monitoring (NICOM): a clinical validation. Intensive Care Med 2007; 33:1191-1194.
21. Cheung H, Dong Q, Dong R, Yu B. Correlation of cardiac output measured by non-invasive continuous cardiac output monitoring (NICOM) and thermodilution in patients undergoing off-pump coronary artery bypass surgery. J Anesth2015; 29:416-420.
22. Rich JD, Archer SL, Rich S. Noninvasive cardiac output measurements in patients with pulmonary hypertension. Eur Respir 2013; 42:125-133.
23. Fellahi JL, Caille V, Charron C, Deschamps-Berger PH, Vieillard-Baron A. Noninvasive assessment of cardiac index in healthy volunteers: a comparison between thoracic impedance cardiography and Doppler echocardiography. Anesth Analg 2009;108:1553-1559.
24. McIntyre JP, Ellyett KM, Mitchell EA,et al. Maternal Sleep in Pregnancy Study Group. Validation of thoracic impedance cardiography by echocardiography in healthy late pregnancy. BMC Pregnancy and Childbirth 2015; 15:70.
25. Kaszuba E, Scheel S, Odeberg H, Halling A. Comparing impedance cardiography and echocardiography in the assessment of reduced left ventricular systolic function. BMC Research Notes2013; 6:114.
26. Weisz DE, Jain A, McNamara PJ, Afif EK. Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography. Neonatology 2012; 102: 61-67.
27. Ballestero Y, López-Herce J, Urbano J,et al. Measurement of cardiac output in children by bioreactance. Pediatr Cardiol 2011; 32:469-472.
Files
IssueVol 60 No 9 (2022) QRcode
SectionArticles
DOI https://doi.org/10.18502/acta.v60i9.11096
Keywords
Children Ultrasound Critical care Fluid therapy Cardiac output Hemodynamic
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Mohammadpour M, Chegini V, Sharif Zadeh M, Yaghmai B, Mirzadeh M, Zeinaloo A. The Value of Noninvasive Continuous Cardiac Output Monitoring in Assessment of Hemodynamic Status in Critically Ill Children. Acta Med Iran. 2022;60(9):554-561.