Abstract
BackgroundPlanning optimal fluid and inotrope-vasopressor-inodilator therapy is essential in critically ill children. Pulse index Contour Cardiac Output (PiCCO) monitoring is an invasive, hemodynamic monitor that provides parameter measurements such as cardiac output (CO), cardiac index (CI). Use of ultrasonography and critical care echocardiography by the pediatric intensivists has increased in recent years. In the hands of an experienced pediatric intensivist, critical echocardiography can accurately measure both CO and CI. Our objective in this study is to compare the CO and CI values measured by pediatric intensivist using critical care echocardiography to the values measured by PiCCO monitor in critically ill pediatric patients.MethodsA prospective observational study from a tertiary university hospital PICU. A total of 15 patients who required advanced hemodynamic monitoring and applied PiCCO monitoring were included the study. The diagnosis of patients were septic shock, cardiogenic shock, acute respiratory distress syndrome, pulmonary edema. Forty nine echocardiographic measurements were performed and from 15 patients. All echocardiographic measurements were performed by a pediatric intensive care fellow experienced in cardiac ultrasound. The distance of left ventricle outflow tract (LVOT) in the parasternal long axis and LVOT-Velocity Time Integral (LVOT-VTI) measurement was performed in the apical five chamber image. Cardiac output_echocardiography (CO_echo) and CI_echocardiography (CI_echo) were calculated using these two measurements. PiCCO (PiCCO, Pulsion Medical Systems, Munich, Germany) monitoring was performed. Cardiac output (CO_picco) and CI (CI_picco) were simultaneously measured by PiCCO monitor and echocardiography. We performed a correlation analysis with this 49 echocardiographic measurements and PiCCO measurements.ResultsWe detected a strong positive correlation between CO_echo and CO_picco measurements (p < 0.001, r = 0.985) and a strong positive correlation between CI_echo and CI_picco measurements (p < 0.001, r = 0.943).ConclusionsOur study results suggest that critical care echocardiography measurement of CO and CI performed by an experienced pediatric intensivist are comparable to PiCCO measurements. The critical care echocardiography measurement can be used to guide fluid and vasoactive-inotropic management of critically ill pediatric patients.
Highlights
Pediatric patients in the pediatric intensive care units (PICU) are at higher risk for hemodynamic instability
Our study results suggest that critical care echocardiography measurement of cardiac output (CO) and cardiac index (CI) performed by an experienced pediatric intensivist are comparable to Pulse index Contour Cardiac Output (PiCCO) measurements
Study population Fifteen patients with diagnosis of septic shock, cardiogenic shock, acute respiratory distress syndrome (ARDS), pulmonary edema who were hospitalized in our PICU and had PiCCO monitoring for unstable hemodynamics and uncertain volume status were included in the study
Summary
Pediatric patients in the pediatric intensive care units (PICU) are at higher risk for hemodynamic instability. Planning appropriate parenteral fluid and inotrope-vasopressor-inodilatory management is vitally important in critically ill pediatric patients [1]. Pulse index Contour Cardiac Output (PiCCO) monitor is a less invasive continuous cardiac output (CO) and hemodynamics monitor which works with transpulmonary thermodilution technology and does not require pulmonary artery catheterization. PiCCO use has increased in the PICU and it guides the pediatric intensivists in planning fluid and inotrope management of the patient by measuring continuous CO and CI, preload, systemic vascular resistance index by means of arterial thermodilution technique and arterial pulse contour analysis [7]. PiCCO monitor is an invasive and expensive technology which limits its utility and availability in all PICUs. Planning optimal fluid and inotrope-vasopressor-inodilator therapy is essential in critically ill children. Our objective in this study is to compare the CO and CI values measured by pediatric intensivist using critical care echocardiography to the values measured by PiCCO monitor in critically ill pediatric patients
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