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Fluid overload is frequently found in critically ill patients with pediatric heart failure.Volume management is one of the important therapeutic measures for pediatric patients with heart failure, the aim of which is to achieve the best individual volume homeostasis.Assessment of volume status is the premise and foundation of volume management.The comprehensive evaluation and effective management of volume status leave clinical doctors a great challenge.In order to provide guidance and evidence for clinicians, this review elucidated the methods for assessment and management of volume status for pediatric patients with heart failure.
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Continuous renal replacement therapy(CRRT)is an important treatment in the pediatric intensive care unit .However, CRRT needs to establish cardiopulmonary bypass.During the initial period of cardiopulmonary bypass , ultrafiltration and blood return, CRRT causes a rapid change of the body′s circulating blood volume due to the transfer of a large amount of fluid, resulting in hemodynamic instability.So accurate and real-time assessment of volume status during CRRT has an extremely important impact on reducing potential abnormal hemodynamic fluctuations and improving the prognosis of critically ill children.This review summarized the volume status assessment during CRRT in critically ill children.
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Ultrasound-measured inferior vena cava (IVC) and abdominal aorta (Ao)-associated parameters have been used to predict volume status for decades, yet research focusing on the impact of individual physical characteristics, including gender, height/weight, body surface area (BSA), and age, assessed simultaneously on those parameters in Chinese children is lacking. The aim of the present study was to explore the impact of individual characteristics on maximum IVC diameter (IVCmax), Ao, and IVCmax/Ao in healthy Chinese children. From September to December 2015, 200 healthy children from 1 to 13 years of age were enrolled. IVCmax and Ao diameters were measured by 2D ultrasound. We found that age (years), height (cm), weight (kg), waist circumference (cm), and BSA (m2) were positively correlated with IVCmax and Ao. Multivariate linear regression showed that age was the only independent variable for IVCmax (mm) in female children, height was the only independent variable for IVCmax in male children, and age was the only independent variable for Ao in both females and males. IVCmax/Ao was not significantly influenced by the subjects' characteristics. In conclusion, IVCmax and Ao were more susceptible to subjects' characteristics than IVCmax/Ao. IVCmax/Ao could be a reliable and practical parameter in Chinese children as it was independent of age, height, and weight.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Aorta, Abdominal/diagnostic imaging , Vena Cava, Inferior/diagnostic imaging , Ultrasonography/methods , Aorta, Abdominal/physiology , Vena Cava, Inferior/physiology , Body Composition/physiology , China , Cross-Sectional Studies , Asian PeopleABSTRACT
Objective · To assess volume status in maintenance hemodialysis (MHD) patients.Methods · Body composition analysis was performed on 128 MHD patients from Renji Hospital,Shanghai Jiao Tong University School of Medicine.The volume status was assessed based on body composition data and predialysis systolic blood pressure (preBPsys),edema grade,brain natriuretic peptide (BNP).Patients were divided into hyperhydrated group (percentage of hydration status,HS％＞ 15％) or normohydrated group (HS％ ≤ 15％).Body composition data were compared,including lean tissue index (LTI) and fat tissue index (FTI).The blood pressure,edema grade,serum calcium,serum phosphate,intact parathyroid hormone (iPTH),hemoglobin,albumin,pre-albumin,hypersensitive C-reactive protein (hs-CRP),serum sodium,and urea clearance Kt/V were compared between two groups.Results · Sixtynine patients were normohydrated and preBPsys reached target;10 patients were overhydrated with higher preBPsys;18 patients had overhydration but preBPsys was in target range.Compared to normohydraed group,patients in hyperhydmted group had more obvious edema,higher BNP level,significantly lower LTI,serum albumin and pre-albumin levels,while serum sodium was significantly higher (P＜0.05).Conclusion· Volume status of hemodialysis patients can be objectively and accurately assessed by body composition analysis using bioimpedance technique with blood pressure,edema grade and biochemical parameters.Hyperhydrated patients may have higher serum sodium level,lower serum albumin,lower hemoglobin,and less lean tissue mass concomitantly.Sodium intake control,nutrition status improvement,and anemia correction may be useful to reduce hyperhydration.
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Objective: To assess volume status in maintenance hemodialysis (MHD) patients. Methods: Body composition analysis was performed on 128 MHD patients from Renji Hospital, Shanghai Jiao Tong University School of Medicine. The volume status was assessed based on body composition data and predialysis systolic blood pressure (preBPsys), edema grade, brain natriuretic peptide (BNP). Patients were divided into hyperhydrated group (percentage of hydration status, HS%>15%) or normohydrated group (HS%≤15%). Body composition data were compared, including lean tissue index (LTI) and fat tissue index (FTI). The blood pressure, edema grade, serum calcium, serum phosphate, intact parathyroid hormone (iPTH), hemoglobin, albumin, pre-albumin, hypersensitive C-reactive protein (hs-CRP), serum sodium, and urea clearance Kt/V were compared between two groups. Results: Sixtynine patients were normohydrated and preBPsys reached target; 10 patients were overhydrated with higher preBPsys; 18 patients had overhydration but preBPsys was in target range. Compared to normohydraed group, patients in hyperhydrated group had more obvious edema, higher BNP level, significantly lower LTI, serum albumin and pre-albumin levels, while serum sodium was significantly higher (P<0.05). Conclusion: Volume status of hemodialysis patients can be objectively and accurately assessed by body composition analysis using bioimpedance technique with blood pressure, edema grade and biochemical parameters. Hyperhydrated patients may have higher serum sodium level, lower serum albumin, lower hemoglobin, and less lean tissue mass concomitantly. Sodium intake control, nutrition status improvement, and anemia correction may be useful to reduce hyperhydration.
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Objective To determine the predictive value of central venous oxygen saturation (ScvO2) in volume response by comparing the relationship between variation of ScvO2 and cardiac output (CO) variability before and after volume expansion in elderly patients with septic shock.Methods Forty-five patients who diagnosed septic shock were enrolled in the study,inserted CVC and were carried out continuous cardiac output monitoring(PICCO) before volume expansion.Every patient was treated by rapid intravenous infusion of 250 mL physiological saline,then take blood gas analysis before and after treated which the blood samples were collected from central venous catheter.The value of ScvO2 and the value of cardiac output was recorded.Degree of variation between two sets of data were tested by Student t-test.The correlation was determined by using Pearson's correlation test.Operating characteristics curve analysis was used to test their ability to distinguish R and NR.Results The mean arterial pressure (MAP)、heart rate(HR)、CO、ScvO2 were demonstrated and have statistical significance (P＜ 0.05) compared with before treated.CO and ScvO2 indexes were positively correlated (P＜0.01) before and after volume expansion.ScvO2 variations after VE were significantly correlated with CO changes after VE (r=0.781,P＜0.01).Conclusion ScvO2 dynamic changes can be used as a criterion for determining the fluid responsiveness.
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objective To investigate the value of NT-proBNP in assessing the volume status in maintenance hemodialysis patients with non-dominant edema.Methods One hundred and forty-five patients were recruited.Bioimpedance measurements were performed for overhydration (OH).NT-proBNP was detected by colloidal gold method.Patients were divided into three groups by levels of OH variability (△ OH,equal to OH minus weight increase) as group H (hypervolemia,n=90); group N (normovolemia,n=36) and group L (hypovolemia,n=19).Hemoglobin,albumin,blood urea nitrogen and serum creatinine were assayed,blood pressure and body mass increase were recorded.Dry weight of patients in Group H were adjusted in 3 months,the relationship between NT-proBNP and volume change were assessed.Results (1) At baseline,overall plasma NT-proBNP levels were higher than normal range.The median NT-proBNP levels in group H and group N were [1318.50(IQR 717.00,3154.25) pg/ml] and [703.50 (IQR 873.00,450.50) pg/ml],respectively.NT-proBNP was positively correlated with △OH value (r=0.801,P ＜ 0.001).(2) After 3 months,NT-proBNP levels in group H was significantly lower than baseline.Forty-one patients reached normal volume range (group H1),49 patients were resistant hypervolemia (group H2).The median NT-proBNP levels in group H1 and group H2 were [685.00 (IQR 422.50,988.50) pg/ml] and [1569.00 (IQR 982.50,2500.50) pg/ml],△ OH in group H1 and group H2 were [(0.63±0.23)L] and [(1.75±0.71)L],respectively.NT-proBNP and △ OH value in two groups had significant difference (P ＜ 0.05).NT-proBNP was positively correlated with △ OH value (r=0.684,P ＜ 0.001).(3) The area under ROC curve for NT-proBNP was 0.818,95％CI (0.733～ 0.904),P ＜ 0.001,since the absolute value of normovolemia was defined as ≤ 1.The cut off value of plasma NT-proBNP was set at 962.50 pg/ml in MHD patients with non-dominant edema,the diagnostic specificity and sensitivity were 79.6％ and 73.2％.Conclusion NT-proBNP could be used to assess volume status in MHD patients with non dominant edema.
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Objective To evaluate the body volume status in maintenance hemodialysis(MHD) children with multi-frequency bioelectrical impedance.Methods Nine end-stage-renal-disease patients undergoing MHD from Aug.2011 to Mar.2012 in blood purification department of Beijing Children's Hospital and 171 cases of healthy control group were investigated.Over hydration (OH),total body water(TBW),extracellular water(ECW),i ntracellular water (ICW) of MHD children pre-and post-hemodialysis and healthy children were measured with the body composition monitor which was based on multi-frequency bioelectrical impedance and the values were standardized by body weight to produce TBW％,ECW％ and ICW％.Results There were statistical differences of OH,TBW,ECW and ECW％ before and after dialysis,but no statistical difference of ICW.By contrast,ECW％ values pre-dialysis were higher,but post-dialysis were lower than that of healthy control group.Pre-and post-dialysis ICW％ values in HD children were similar to those of healthy control group.Conclusions ECW％ increased in MHD children;the main function of normal hemodialysis is to remove extra ECW,which has little effect on ICW.The measurement of multi-frequency bioelectrical impedance can provide an objective basis for capacity status.
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BACKGOUND: Brain natriuretic peptide (BNP, b-type natriuretic peptide) is released into circulation in response to ventricular dilatation and pressure overload. In the general population, the plasma concentration of BNP are useful to predict left ventricular hypertrophy (LVH) and LV systolic dysfunction. Whether these cardiac hormone have correlation with hydration state in hemodialysis (HD) patients is unclear. METHODS: We measured the pre-HD and post-HD plasma BNP level in 36 HD patients and evaluated their cardiac state with echocardiography and their fluid overload state with chest X-ray. We checked intradialytic HD weight gain and ultrafiltration volume, as a marker of hydration status. RESULTS: Mean pre-HD BNP level of 36 HD patients was 545.79 pg/mL and mean post-HD BNP level was 503.64 pg/mL. And mean BNP level of 10 healthy adults was 13.46 pg/mL. In 29 patients, BNP level was decreased after HD. But BNP levels of 7 patients were paradoxically increased after HD. Ultrafiltration volume was smaller in these patients (p=0.03) and post-HD blood pressure was higher (p=0.048). Plasma BNP level was significantly increased in 17 patients with pulmonary congestion or cadiomegaly (p=0.005). But pre-HD BNP level did not correlated with pre-HD blood pressure. BNP reduction ratio was higher in larger ultrafiltration (UF) volume (>3 L) group than in smaller UF volume group (p=0.02). There were no difference in BNP levels between DM and non-DM group. CONCLUSION: Plasma BNP level seems to be a limited but useful, marker of volume status in HD patients.