Background

Stroke volume (SV) and cardiac output monitoring is a cornerstone of hemodynamic assessment. Non-invasive technologies are increasingly used in pediatrics.

Objectives

This study compared SV measurements obtained by transcutaneous Doppler ultrasound techniques (USCOM), transthoracic echocardiography jugular (TTE-J), and apical views (TTE-P) performed by cardiologists and non-cardiologists in pediatric spontaneously ventilating patients.

Methods

A single center study was conducted on patients aged 7.6±4.65 years. In total, 37 patients were enrolled in the study. USCOM and TTE were used to measure SV. Each operator obtained three sets of USCOM measurements within a period of 3–5 minutes, followed with TTE measurements from both apical and suprasternal views. The USCOM and TTE evaluations were performed by two investigators—operator A, non-cardiologist (OP-A) and operator B, cardiologist (OP-B).

Results

Both USCOM and TTE methods were applicable in 89% of patients. The intra-observer variability of USCOM measurements were 5.4 (5.6) and 7.9 (8.0) in OP-A and OP-B, respectively. The intra-observer variability of TTE-J and TTE-P measurements were 5.8 (5.4) and 6.2 (4.0) in OP-A and 6.5 (4.3) and 7.8 (5.8) in OP-B. The percentage error in SV with USCOM was 39% relative to TTE-J in OP-A and 46% in OP-B. The percentage error in SV with TTE-P was 33% relative to TTE-J in OP-A and 19% in OP-B.

Conclusion

TTE-P requires longer practice in comparison to TTE-J in non-cardiologist. The methods are not interchangeable as SV values by USCOM are higher in comparison to the SV values obtained by TTE.

Study was supported by the Charles University Research Fund (Progres Q39).

Background

Early and easy to do detection of left ventricular (LV) failure is crucial to improve following and outcomes of patients with right ventricular (RV) overload in congenital heart diseases. Electrical cardiometry is easy handling, even in medical office or in pre-hospital condition, and can provide cardiac output, and a new contractility index (ICON) (Osypka medical) supposed to be independent from load conditions. ICON have never been previoulsy challenged to our knowledge.

Objectives

We aim to compare ICON with the only contractility parameter independent from load conditions : the elastance slope (Emax).

Methods

Using porcine models of Fallot repaired and pulmonary hypertension (PH), we assess LV function using conductance catheter and electrical cardiometry devices over 4 months after surgery. We measured ICON, Emax, Contractile reserve (ΔE_max) and VIC (respiratory variations of ICON) at basal state and after adrenergic stimulation (Dobutamine).

Results

3 animals of each group were compared with 6 controls. Non parametric correlation (spearman) hightlights at basal state a non significant and low correlation between ICON and Emax and ΔEmax (r=0.5). However after Dobutamine, correlation is important and strong with r=0.98 between ICON/Emax (0.05) and 0.89 between VIC/Emax. We did not find strong correlation between ΔEmax and VIC or ΔICON.

Conclusion

These results obtain on a small in vivo /animal cohort highlight than electrical cardiometry device could be a usefull and easy handling (4 skin patchs) tool for LV failure and loss of contractility early screening, specially after adrenergic stimulation and stress conditions. It could provide precious help in patients following.

Background

Most newborn infants make the transition from intrauterine to extrauterine life without difficulty. However, among very low birth weight (VLBW) infants, approximately 90% need some kind of resuscitation and 4–10% require cardiac compression or medication. Medical resources differ between countries and hospitals, as well as at different times of day and days of the week. Therefore, it is useful to be able to predict the need for resuscitation earlier than immediately prior to delivery, in order to save medical resources, especially in hospitals where they may be limited.

Objectives

To analyze the risk factors for extensive cardiopulmonary resuscitation in the delivery room and develop a prediction model for outcomes in very low birth weight (VLBW) infants.

Methods

The sample was 5298 VLBW infants registered in the Korean neonatal network database from 2013 to 2015. Univariate and multivariate analyses were used to analyze the risk factors for extensive resuscitation. In addition, a multivariable model predicting extensive resuscitation in VLBW infants was developed.

Results

Lower gestational age and birth weight, and male sex were associated with extensive resuscitation. Perinatal characteristics predicting extensive infant resuscitation were hypertension, abnormal amniotic fluid volume, histologic chorioamnionitis, and less use of antenatal steroid. The final prediction model for extensive resuscitation included gestational age, amniotic fluid, and antenatal steroid use.

Conclusion

Lower gestational age, abnormal amniotic fluid volume, and less use of antenatal steroid in VLBW infants are important predictors of extensive resuscitation in the delivery room.

Background

Mechanical ventilation (MV) is associated with atrophy and weakness of the diaphragm. Ultrasound is a feasible, noninvasive method to check it.

Objectives

To quantify diaphragm atrophy (DA) in mechanically ventilated patients and to analyze the risk factors for its development.

Methods

Prospective observational single-center study. Patients: Newly intubated critically ill children. Diaphragm thickness at end-inspiration (TEI) and end-expiration (TEE) in the zone of apposition was measured (first 24 hours, at 72 h, weekly thereafter, and seven days after extubation) with ultrasound. A descriptive (median and IQR) and a bivariate analysis was performed.

Results

From June to December 2018, 47 subjects [median age 3 months (1-17)] underwent 164 ultrasonographic evaluations. Median duration of MV was 168 hours (96–196). At baseline, TEI was 2.2 mm (1.8–2.5) and TEE 1.8 mm (1.5–2.0). The change in TEE during MV was –14% (–33% to -3%), with a –2% daily atrophy rate (–4.2% to 0%). 31 subjects received neuromuscular blockade, with a significant reduction in TEE (-25% [-45% to 0%] vs -6% [-42% to 0%], p=0.001) and an increase in daily atrophy rate (-2.2%, -11 to 0%) compared with unexposed patients (-1.4%,[-4 to 0], p=.049). Children with a short period of spontaneous breathing (<12 hours) had a significant decrease in TEE compared with those with higher spontaneous breathing fraction [-26% (-45-0%) versus -9.5% (-45-0%), p=0.011].

Conclusion

A strong association between DA, MV and neuromuscular blockade and an inverse relation with the spontaneous breathing fraction was found. Ultrasound seems to be useful in detecting progressive DA.