Continuous arterial pressure waveform monitoring in pediatric cardiac transplant, cardiomyopathy and pulmonary hypertension patients
Division of Critical Care, Department of Pediatrics, The Children's Hospital, Aurora, CO, USA. Intensive Care Medicine
(Impact Factor: 7.21).
05/2011; 37(8):1297-301. DOI: 10.1007/s00134-011-2252-y
A continuous cardiac output monitor based on arterial pressure waveform (FloTrac/Vigileo; Edwards Lifesciences, Irvine, CA) is now approved for use in adults but not in children. This device is minimally invasive, calculates cardiac output continuously and in real time, and is easy to use. Our study sought to validate the FloTrac with the pulmonary artery catheter (PAC) intermittent thermodilution technique in pediatric cardiac patients.
This was a prospective pilot study comparing cardiac output measurements obtained via the FloTrac and arterial pressure waveform analysis with intermittent thermodilution. Subjects carried the diagnosis of pulmonary hypertension or cardiomyopathy, or were in the postoperative course after orthotopic heart transplantation.
Enrolled in the study were 31 subjects, and 136 data points were obtained. The age range was 8 months to 16 years. The mean body surface area (BSA) was 1.1 m(2). Bland-Altman plots for the mean cardiac outputs of all subjects with a BSA ≥ 1 m(2) showed limits of agreement of -2.7 to 8.0 l/min (± 5.4 l/min). Patients with a BSA ≤ 1 m(2) demonstrated even wider limits of agreement (± 8.5 l/min). The intraclass correlation for the PAC was 0.929 and 0.992 for the FloTrac.
There was poor agreement between the PAC and FloTrac in measuring cardiac output in a population of children with pulmonary hypertension or cardiomyopathy, or after cardiac transplantation. This is in contrast to adult studies published thus far. This suggests that the utility of the FloTrac and measurements obtained from arterial pulse wave analysis in children is uncertain at this time.
Available from: Hong Liu
- "The distinction of this ability is its prediction of arterial compliance and resistance based on age, sex, height, weight, and body surface area. There are some instances, such as non-traumatic intracranial hemorrhage, children with pulmonary hypertension or cardiomyopathy, or after cardiac transplantation, where the data has shown poor correlation with traditional thermodilution technique. In general, data have deemed the estimation of cardiac output by each of above systems to be interchangeable with that from a PAC. "
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ABSTRACT: Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk procedures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy.
Available from: Jordi Mancebo
Available from: Daryl J Kor
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ABSTRACT: This article reviews potential pediatric applications of 3 new technologies. (1) Pulse oximetry-based hemoglobin determination: Hemoglobin determination using spectrophotometric methods recently has been introduced in adults with varied success. This non-invasive and continuous technology may avoid veni-puncture and unnecessary transfusion in children undergoing surgery with major blood loss, premature infants undergoing unexpected and complicated emergency surgery, and children with chronic illness. (2) Continuous cardiac output monitoring: In adults, advanced hemodynamic monitoring such as continuous cardiac output monitoring has been associated with better surgical outcomes. Although it remains unknown whether similar results are applica-ble to children, current technology enables the monitoring of cardiac output non-invasively and continuously in pediatric patients. It may be important to integrate the data about cardiac output with other information to facilitate therapeutic interventions. (3) Anesthesia information management systems: Although perioperative electronic anesthesia information management sys-tems are gaining popularity in operating rooms, their potential functions may not be fully appreciated. With advances in information technology, anesthesia information management systems may facilitate bedside clinical decisions, administrative needs, and research in the perioperative setting.
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