Predictive value of ultrasonic cardiac output monitor in premature infants with hemodynamic significant patent ductus arteriosus / 中华实用儿科临床杂志

Objective:To evaluate the diagnostic and predictive value of ultrasonic cardiac output monitor (USCOM) in premature infants with hemodynamic significant patent ductus arteriosus (hsPDA).Methods:A total of 165 preterm infants with gestational age less than 34 weeks and within 72 hours after birth in the Neonatal Medical Center of Children′s Hospital of Nanjing Medical University from January 2018 to June 2020 were retrospectively analyzed.According to the echocardiograph (ECHO) results within 72 hours after birth, clinical manifestations and oral administration of Ibuprofen, premature infants were divided into non-patent ductus arteriosus (non-PDA group, 77 cases), non-hsPDA group (59 cases), and hsPDA group (29 cases). USCOM was performed within half of an hour after ECHO.During the course of oral medication of Ibuprofen in the hsPDA group, USCOM was repeatedly examined every 24 hours.ECHO and USCOM were re-examined within 24 hours after the course of oral medication of ibuprofen.Results:Compared with non-hsPDA group and non-PDA group, the gestational age [(31.51±1.62) weeks, (32.09±1.27) weeks vs.(30.82±1.61) weeks, F=8.425, P<0.001], birth weight [(1 154.49±192.55) g, (1 195.58±182.02) g vs.(1 094.66±153.69) g, F=3.366, P=0.037] and the mean blood pressure [(38.37±2.20) mmHg, (38.53±2.37) mmHg vs.(30.52±2.31) mmHg, 1 mmHg=0.133 kPa, F=142.860, P<0.001]were significantly lower in hsPDA group.On the contrary, the heart rate[(129.68±7.11) times/min, (130.34±7.27) times/min vs.(164.76±7.65) times/min, F=271.790, P<0.001], B-type natriuretic peptide[(203.76±108.68) ng/L, (152.43±54.24) ng/L vs.(3 385.31±856.26) ng/L, F=931.30, P<0.001] and left artrium/aorta (1.32±0.12, 1.29±0.09 vs.1.60±0.12, F=84.970, P<0.001)were significantly higher.Among the USCOM parameters, left ventricular cardiac output [(0.40±0.08) L/min, (0.40±0.08) L/min vs.(0.51±0.04) L/min, F=26.760, P<0.001], cardiac index (CI) [(3.76±0.48) L/(min·m 2), (3.54±0.30) L/(min·m 2) vs.(4.43±0.36) L/(min·m 2), F=56.060, P<0.001], stroke volume[(3.75±0.28) mL, (3.70±0.23) mL vs.(4.22±0.36)mL, F=40.170, P<0.001], stroke volume index [(34.42±2.66) mL/m 2, (34.47±3.29) mL/m 2vs.(38.45±3.32) mL/m 2, F=20.080, P<0.001], peak ejection velocity [(1.12±0.12) m/s, (1.11±0.10) m/s vs.(1.23±0.09) m/s, F=14.890, P<0.001] and corrected flow time [(379.02±22.69) ms, (376.51±27.95) ms vs.(403.69±39.04) ms, F=10.120, P<0.001]were significantly higher in hsPDA group, while systemic vascular resistance index (SVRI) [(1 109.49±115.67) ds·cm -5·m 2, (1 070.01±133.55) ds·cm -5·m 2vs.(861.31±115.22) ds cm -5m 2, F=41.130, P<0.001]was significantly lower than that of non-hsPDA and non-PDA group.The area under the receiver operating characteristic curve of CI and SVRI for predicting hsPDA were 0.916 and 0.905, respectively.The sensitivity and specificity of CI>4.05 L/(min·m 2) for predicting hsPDA was 0.828 and 0.860, respectively, which was 0.660 and 1.000 for SVRI<1 002.5 ds·cm -5·m 2.The sensitivity and specificity of combining CI and SVRI for predicting hsPDA was 0.966 and 0.949, respectively. Conclusions:USCOM has a good diagnostic and predictive value for hsPDA in premature infants.The combined application of CI and SVRI can improve the predictive value, and help formulate the early diagnostic and treatment strategy for PDA in premature infants

Assessment of left ventricular function and hemodynamics in infantile pneumonia by ultrasonic cardiac output monitor / 中华实用儿科临床杂志

Objective:To assess the left ventricular function and hemodynamic status in infantile pneumonia by ultrasonic cardiac output monitor (USCOM).Methods:The clinical data of 74 children with infantile pneumonia hospitalized in the Department of Pediatrics of Affiliated Hospital of North Sichuan Medical College from October 2018 to January 2020 were collected in this study, and those cases were divided into the mild pneumonia group (45 cases) and the severe pneumonia group (29 cases). USCOM was employed to measure such data of patients in both groups as heart rate (HR), flow time corrected (FTc), stroke volume variability (SVV), stroke volume index (SVI), cardiac index (CI), inotropy index(INO), and systemic vascular resistance index (SVRI). The specific values of CI and SVRI in all ages were employed to determine the hemodynamic type.According to values of CI, they were grouped into normal, high and low output; according to values of SVRI, they were grouped into normal, high and low resistance.The left ventricular function and hemodynamic status of infants with pneumonia in both groups were compared.Results:(1) In the mild pneumonia group, 42.22% of infants (19/45 cases) presented with abnormal hemodynamic status, of which 94.74% were high-output and low-resistance type.In the severe pneumonia group, 79.31%(23/29 cases) of infants presented with abnormal hemodynamic status, of which 86.96%(20/23 cases) were non-high-output and non-low-resistance type.The proportion of different hemodynamic types from high to low in order is as follows: low-output and high-resistance (39.13%), high-output and normal-resistance (26.09%), low-output and low-resistance (13.04%), and normal-output and low-resistance (8.70%). (2)Before treatment, HR, SVI, CI, INO and SVRI in the severe pneumonia group and the mild pneumonia group were (153.2±19.3) times/min, (32.0±5.8) mL/m 2, (4.3±1.0) L/(min·m 2), (1.1±0.4) W/m 2, (1 139.0±280.6) d·s·cm -5·m 2 and(140.2±13.2) times/min, (39.2±4.1) mL/m 2, (5.1±0.8) L/(min·m 2), (1.4±0.2) W/m 2, and (904.7±175.8) d·s·cm -5·m 2, respectively.SVI, CI and INO in the severe pneumonia group were lower than those in the mild pneumonia group, which indicated that the difference was statically significant (all P<0.05). HR and SVRI in the severe pneumonia group were higher than those in the mild pneumonia group, which indicated that the difference was statically significant (all P<0.05). There was no significant difference in cardiac preload between both groups before treatment ( P>0.05). HR in the severe pneumonia group after treatment[(137.6±9.3) times/min] were significantly lower than before treatment, while SVI and CI[(36.2±3.4) mL/m 2, (4.7±0.3)L/(min·m 2)] were higher than before treatment, which indicated that the differences were statistically significant (all P<0.05). Conclusions:The USCOM provided a rapid approach for the dynamic measurement of left ventricular function and hemodynamic status.As per the findings with USCOM, more infants with mild pneumonia presented with hemodynamic abnormalities, and most of them were high-output and low-resistance types.The majority of infants with severe pneumonia presented with different types of hemodynamic abnormalities, and most of them were non-high-output and non-low-resistance types, which can return to normal after treatment.

Concordancia del volumen telediastólico final del ventrículo izquierdo medido por monitor ultrasónico y ecocardiografía / Concordance of the final telediastolic volume of the left ventricle measured by ultrasonic monitor and echocardiography / Concordância do volume telediastolólico final do ventrículo esquerdo medido por monitor ultra-sônico e ecocardiografia

Resumen: Antecedentes: La sepsis se ha asociado a alta mortalidad y disfunción cardiaca; la ecocardiografía es técnicamente difícil; el operador dependiente requiere personal capacitado y equipo disponible, por lo que la fórmula de Smith & Madigan (SMII), a través del monitor ultrasónico de gasto cardiaco, es un sustituto adecuado del inotropismo, pudiéndose inferir el volumen telediastólico final del ventrículo izquierdo (VDFVI) como un indicador de precarga. Métodos: En 56 pacientes diagnosticados con shock séptico, se midieron las siguientes fórmulas usando monitor ultrasónico de gasto cardiaco y comparándose con el volumen telediastólico final por ecocardiografía. SMII = (VS × (PAM - PVC + Gp))/(7.5 × SC × TF) VDFVI = VS × 2.7/SMII. Resultados: Comparamos los resultados medidos por ecocardiografía y fórmula de Smith & Madigan, usando el método de Bland & Altman, obtuvimos un R2=0.92, un coeficiente de Linn de 0.92 con LC95% más alto 32.45, LC95% inferior-39.45 y una tasa de error de 32%. Conclusión: La fórmula de Smith & Madigan podría ser útil para el cálculo de volumen telediastólico final del ventrículo izquierdo; aunque debemos determinar si esta medida es útil para tomar decisiones clínicas, ya que el porcentaje de error es mayor al 20%.

Abstract: Background: Sepsis has been associated with high mortality and cardiac dysfunction, echocardiography is technically difficult, depends on the operator, requires trained personnel and available equipment, so the Smith & Madigan formula (SMII) through the cardiac output monitor Ultrasonic is an adequate substitute of inotropism, being able to infer the final end-diastolic volume of the left ventricle (VDFVI) as indicator of preload. Methods: In 56 patients diagnosed with septic shock, the following formulas were measured by an ultrasonic cardiac output monitor and compared with final end-diastolic volume by echocardiography. SMII = (VS × (PAM-PVC + Gp))/(7.5 × SC × TF) VDFVI = VS × 2.7/SMII. Results: We compared the results measured by echocardiography and the Smith & Madigan formula, using the Bland & Altman method, we obtained an R2 = 0.92, a Linn coefficient of 0.92 with an LC95% higher 32.45, LC95% Lower - 39.45 and a 32% error rate. Conclusion: The Smith & Madigan formula could be useful for the calculation of final end-diastolic volume of the left ventricle. Although the percentage of error is greater than 20%, we must determine if this measure is useful for making clinical decisions.

Resumo: Contexto: A sepse tem sido associada com alta mortalidade e disfunção cardíaca. O ecocardiograma é tecnicamente difícil, operador dependente, requer pessoal treinado e equipamentos disponíveis de modo que a fórmula de Smith & Madigan (SMII) através do monitor ultra-sônico de débito cardíaco é um substituto adequado do inotropismo, sendo capaz de inferir o volume diastólico final do ventrículo esquerdo (VDFVI) como um indicador de pré-carga. Métodos: Foram mensuradas as seguintes fórmulas em 56 pacientes com diagnóstico de choque séptico, por meio de um monitor ultra-sônico do débito cardíaco e comparadas ao volume telediastólico ao final pelo ecocardiograma. SMII = (VS × (PAM-PVC + Gp))/(7.5 × SC × TF) VDFVI = VS X 2.7/SMII. Resultados: Comparou-se os resultados medidos pela ecocardiografia e a fórmula de Smith & Madigan utilizando o método de Bland & Altman, obtivemos um R2 = 0.92, um coeficiente de Linn de 0.92 com um LC95% maior 32.45, LC95% Inferior - 39.45 e uma Taxa de erro de 32%. Conclusão: A fórmula de Smith & Madigan poderia ser útil para o cálculo do volume telediastólico final do ventrículo esquerdo. Embora a porcentagem de erro seja maior que 20% devemos determinar se essa medida é útil para tomar decisões clínicas.

The predictive values of stoke volume variation and corrected flow time in fluid therapy responsiveness in neonatal septic shock / 中国新生儿科杂志

Objective To study the predictive value of hemodynamic monitoring in the responsiveness of fluid therapy in neonatal septic shock.Method The 96 neonates with septic shock admitted to the NICU from Wuhan Children's Hospital and Tongji Hospital between March 2014 to May 2017 were enrolled.Hemodynamics parameters of neonates pre-,1 hour and 6 hour post-fluid therapy were supervised by ultrasonic cardiac output monitor.The hemodynamics parameters included cardiac index (CI),systemic vascular resistance (SVR),stroke volume (SV),stroke volume variation (SVV),stroke volume index (SVI) and corrected flow time (FTc).The SVI variation (△ SVI) were calculated based on the SVI among pre-and post-fluid therapy.According to the △ SVI,these samples were assigned into two groups,responsive group with a △ SVI ≥10％,and the other was nonresponsive group respectively.T-test was applied to analyze the differences of hemodynamic parameters between two groups.The associations between SVV、FTc and △ SVI were evaluated by bivariate correlation.Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of SVV and FTc in fluid responsiveness.All statistical analyses were performed by SPSS 19.0,P＜0.05 was considered as statistically significant.Result A total of 96 cases were enrolled,of which 54 were fluid responsive group,while 42 were nonresponsive group.(1) Before fluid resuscitation,the FTc in responsive and nonresponsive groups were (317.1±22.2) ms and (326.8± 21.2) ms (P＜0.05) respectively,SVV were(18.3±2.0)％ and (15.0±2.6)％ (P＜0.05).SVV was significantly associated with △ SVI (r=0.542,P＜0.05).(2) There were statistically significant differences in heart rate,mean arterial pressure,cardiac output,cardiac index,stroke volume and systemic vascular resistance index before treatment,1 h and 6 h after treatment (P＜0.05).(3) The area under the ROC of SVV (AUC) was 0.838 (95％CI 0.749～0.906).A sensitivity of 98.2％,and specificity 73.8％ when SVV defined as 15.5％,with a significant difference when compared with FTc (AUC=0.642,95％CI 0.538～0.737) (P＜0.01).Conclusion SVV could be a reliable predictive index in estimating fluid responsiveness of neonatal septic shock and could be helpful parameter in clinic diagnosis.

Application of Non-invasive Volume Parameters to Prediction of Fluid Responsiveness in Children Undergoing Congenital Heart Surgery / 华中科技大学学报(医学版)

Objective To use ultrasonic cardiac output monitor(USCOM)to monitor the hemodynamics of children who un-derwent congenital heart disease(CHD)surgery before and after fluid therapy,and to examine the accuracy of the hemodynamic parameters central venous pressure(CVP),stroke volume variation(SVV),corrected flow time(FTc)and smith madigan inotro-py index(SMII)in predicting fluid responsiveness of children post operation.Methods USCOM was used to monitor the hemo-dynamic parameters of post-operative children before and after fluid therapy.The change of SVI(ΔSVI)was calculated based on the stroke volume index(SVI)before and after fluid therapy,and the inotropic scores(IS)were obtained based on the doses of in-otropic drugs used.Children with ΔSVI≥ 15% were defined to be responders who responded to fluid resuscitation and those with ΔSVI < 15% as non-responders.Two subgroups were also established in terms of IS:IS ≤ 10 group and IS > 10 group.Results Among the parameters(CVP,FTc and SM,etc.),only the area under the ROC curve(AUC)of SVV was signifi-cantly different between before and after fluid therapy(AUC 0.776,P < 0.01).Subgrouping analysis also showed significant difference in only the AUC of SVV between IS≤ 10 group and IS> 10 group(AUC:0.732,P =0.045 or 0.813,P =0.002). Conclusion SVV monitored by USCOM,in contrast to CVP,FTc and SMII,can predict the fluid responsiveness in children af-ter congenital heart surgery.Prediction of fluid responsiveness by SVV shows higher accuracy in IS>10 group than in IS≤10 group.

Comparison of ultrasonic cardiac output monitor and pulse indicated continuous cardiac output monitor on determination of hemodynamic parameters in critical patients / 中华危重病急救医学

Objective To evaluate the difference and correlation between ultrasonic cardiac output monitor (USCOM) and pulse indicated continuous cardiac output (PiCCO) monitor on determination of hemodynamic parameters in critical patients.Methods A prospective observation self-control study was conducted.The critical patients who need hemodynamics monitoring,and admitted to Department of Critical Care Medicine of Peking University People's Hospital from March 2013 to December 2015 were enrolled.Cardiac output (CO),cardiac index (CI),stroke volume (SV),and stroke index (SI) were determined by PiCCO using thermodilution method at immediately (0 hour) and 24 hours after successful location of PiCCO catheter for 3 times then the above indexes were measured with USCOM,and the average values were chosen for statistical analysis.The differences in above parameters between the two methods,and the correlation of the parameters monitored by two methods were evaluated by Pearson linear correlation method,the consistency test was conducted by Bland-Altman method.Results In 31 critical patients enrolled,there were 18 males and 13 females,aging 29-89 years old with the mean of (48.1 ± 36.3) years,body mass of (68.7 ± 17.5) kg,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of 21.2 ± 3.1.CO,CI,SV,and SI detected by USCOM were significantly higher than those detected by PiCCO [CO (L/min):6.32 ± 1.98 vs.5.86 ± 1.72,t =4.887,P =0.000;CI (mL· s-1· m-2):61.68 ± 20.17 vs.56.84± 17.34,t =5.189,P =0.000;SV (mL):61.9 ± 19.7 vs.57.0± 16.9,t =3.977,P =0.000;SI (mL/m2):36.84 ± 12.67 vs.33.33 ± 10.79,t =4.278,P =0.000].It was shown by correlation analysis that CO,CI,SV,and SI monitored by USCOM and PiCCO was positively correlated (R2 value was 0.795,0.798,0.837,and 0.827,respectively,all P =0.000).It was shown by Bland-Altman analysis that the mean CO change (ΔCO) from 0 hour to 24 hours was 0.1 L/min,and the 95％ confidence interval was-0.62 to 0.80.Conclusion There was significant difference in the comparison of hemodynamics parameters monitored by USCOM and PiCCO respectively in critical patients,the overall values monitored by USCOM were higher than those monitored by PiCCO monitoring,but the correlations were good.