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Background:An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries. Aim: The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). Settings and Design: We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaSHemodynamicNavigator systemand the gold standardTDmethod using pulmonary artery catheterin patients undergoingOPCAB.Atotal of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery. Patients and Methods: We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e.TD-CO and RIC-CO as recommended by Bland and Altman.The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve. Results: Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres.The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%. Conclusion: A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.
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Objective To explore the application value of noninvasive cardiac output monitoring (NICOM) in children with sepsis. Methods A total of 51 children with sepsis admitted to pediatric inten-sive care unit in Chengdu Women and Children's Center Hospital were enrolled. They were divided into three groups:sepsis without cardiovascular functional disorder group( sepsis group,n＝16),septic shock compen-sation group (n＝22),septic shock decompensation group (n＝13). The cardiac function of the children was detected by NICOM and echocardiography at the time of admission 0 hours and 1 hours after admission re-spectively. Cardiac index (CI),stroke volume(SV) measured by NICOM and ejection fraction (EF),SV measured by echocardiography were recorded. The correlation between CI and EF at 0 hours and 1 hours after admission was analyzed,and the SV measured by the two methods were compared. Results (1) In the sep-sis group,the CI measured by NICOM was(3. 54 ± 0. 36) L/( min·m2) and EF measured by echocardio-graphy was (66. 9 ± 4. 4)%. There was a significant positive correlation between CI and EF(r＝0. 941,P<0.01).(2) In the septic shock compensation group,CI was (2.40 ±0.36) L/(min·m2) and EF was (51. 91 ± 4. 38)% at 0 hours after admission,and there was a positive correlation between CI and EF( r＝0. 751,P＝0. 023). CI was(2. 98 ±0. 37)L/(min·m2)and EF was(59. 41 ±4. 39)% at 1 hours after admis-sion,and there was a positive correlation between CI and EF (r＝0. 879,P＝0. 012). At 0 hours and 1 hours after admission,the value of SV measured by NICOM was very close to that measured by echocardiography, and there was no significant difference(P>0. 05). (3) In the septic shock decompensation group,CI was (1.26 ±0.28) L/(min·m2) and EF was (41.23 ±4.73)% at 0 hours after admission,and there was no positive correlation between CI and EF(r＝0. 515,P＝0. 121). CI was(1. 61 ± 0. 32)L/(min·m2)and EF was(47. 77 ± 6. 19)% at 1 hours after admission,and there was no positive correlation between CI and EF (r＝0. 531,P＝0. 085). There was significant difference between the value of SV measured by NICOM and that measured by echocardiography at 0 hours and 1 hours after admission (P<0. 05). Conclusion NICOM can accurately evaluate cardiac output when the hemodynamics is stable,but the results are not accurate when the hemodynamics is unstable. NICOM has certain application value in pediatric critical care.
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Objective To study the influence of continuous blood purification(CBP) on cardiac out-put of pediatric patients using bioreactance. Methods Patients underwent CBP in PICU and nephrology ward from March 2014 were prospectively enrolled after approval by ethics committee. CBP therapies were all performed by Fresenius Medical Care hemodialysis machine. Cardiac output values were obtained using the non-invasive cardiac output monitoring ( NICOM) device ( Cheetah Medical). Blood pressure, heart rate, cardiac index(CI) and stroke volume index(SVI) were recorded before the therapy,at the beginning of ther-apy,during the course of therapy,and at the end of each therapy. Results Twenty-one pediatric patients (from 1. 0 year to 15. 5 years) were recruited and 69 treatments were recorded from March 2014 to Decem-ber 2016. The basic CI was 3. 4 (2. 4,6. 1) L/(min·m2),basic SVI was 43 (26,75) ml/(m2·beat). Dur-ing the beginning of therapy,mean arterial pressure(MAP),CI and SVI all dropped from the baseline ( P<0. 001),whereas heart rate increased. During the course of CBP,CI and SVI (were both recorded every 4 hours) kept on dropping and stayed at a relatively lower level. Course CI was 3. 0 (2. 4,4. 6) L/(min·m2) and course SVI was 28 (21,57) ml/(m2·beat). At the end of therapy,CI was 3. 4 (2. 5,5. 3) L/(min· m2),with no significant difference from the baseline CI (P＝0. 073). However,the SVI at the end of therapy was 35 (25,67) ml/(m2·beat),higher than the course SVI but still lower than the basic SVI,the differences were statistically significant ( P<0. 05). Conclusion CI and SVI continue to decline at the beginning of CBP treatment and remain at a lower level throughout the course of treatment. After the therapy, CI has returned to the basic level whereas SVI has not recovered.