lectrical cardiometry compared to transesophageal doppler for hemodynamics monitoring and fluid management in pediatrics undergoing Kasai operation. A randomized controlled trial.
Introduction Infants suffering from biliary atresia commonly undergo hepatoportoenterostomy (Kasai procedure) without car- diac output (CO) monitoring and with only a central ve- nous pressure (CVP) catheter to guide fluid require- ments. Aim is to evaluate non-invasive electrical bioimpedance card...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Pediatric Anesthesia and Critical Care Journal
2018-01-01
|
| Series: | Pediatric Anesthesia and Critical Care Journal (PACCJ) |
| Subjects: | |
| Online Access: | http://www.anestesiarianimazione.com/PACCJ%202018/Electrical%20cardiometry%20compared%20to%20transesophageal%20doppler%20for%20hemodynamics%20monitoring%20and%20fluid%20management%20in%20pediatrics%20undergoing%20Kasai%20operation%20A%20randomized%20trial.pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Introduction
Infants suffering from biliary atresia commonly undergo hepatoportoenterostomy (Kasai procedure) without car- diac output (CO) monitoring and with only a central ve- nous pressure (CVP) catheter to guide fluid require- ments. Aim is to evaluate non-invasive electrical bioimpedance cardiometry (EC) compared to minimally invasive transoesophageal Doppler (TED) for CO moni- toring and fluid management and relationship with CVP .
Material and methods
A prospective randomized controlled study. 42 infants: TED (n=21), and EC (n=21). Intravenous fluids were guided by stroke volume variation (SVV) (%) of EC and corrected flow time (FTc) (msec) of TED with CVP monitored in all.
Results
Median [Interquartile] age (74 [58-86] vs. 73 [62-80] days, p=0.56), weight, (5.0 [4.2-5.2] vs. 5.0 [5.0-5.5] kg, p=0.11), operative time 6[5-6] vs. 6[5-6] hours (h)
p=0.47) and crystalloids intake (300[275-330] vs. 300[270-336] ml, p=0.59) in EC and TED respectively. EC CO was constantly higher than TED CO (l/min) 0.95[0.87-1.2] vs. 0.9[0.7-1.1] p=0.001 and 1.02[0.87- 1.31] vs. 0.8[0.7-1.25], p=0.001, post-induction and mid-surgery respectively. A good degree of reliability between TED and EC CO: post-induction, (Intra-class correlation (ICC) =0.693, p<0.001), 1st h (ICC=0.744, p<0.001), 2nd h (ICC=0.739, p<0.001), 3rd h (ICC=0.769, p<0.001) and 4th h (ICC= 0.617, p=0.002). Bland and Altman analysis of CO (l/min) between EC and TED showed reasonable bias [mean] but broad li- mits of agreement (± 2 SD): Post-induction: 0.122 (0.636 to -0.391), 1st h 1: 0.147 (0.605 to -0.310), 2nd h: 0.130 (0.616 to -0.356), 3rd h: 0.162 (0.578 to -0.253), 4th h: 0.172 (0.724 to -0.379). FTc negatively correlated with SVV and CVP .
Conclusions
Both methods were able to monitor the trend changes of CO and equally guide fluid management, with a good degree of reliability, but their limits of agreement werenoted to be wide. This invites further development in the technology to improve their CO absolute values and improve precision. |
|---|---|
| ISSN: | 2281-8421 |