Abstract
BackgroundNon-Invasive Venous waveform Analysis (NIVA) is novel technology that captures and analyzes changes in venous waveforms from a piezoelectric sensor on the wrist for hemodynamic volume assessment. Complex cranial vault reconstruction is performed in children with craniosynostosis and is associated with extensive blood loss, potential life-threatening risks, and significant morbidity. In this preliminary study, we hypothesized that NIVA will provide a reliable, non-invasive, quantitative assessment of intravascular volume changes in children undergoing complex cranial vault reconstruction.ObjectiveTo present proof-of-concept results of a novel technology in the pediatric population.MethodsThe NIVA prototype was placed on each subject’s wrist, and venous waveforms were collected intraoperatively. Estimated blood loss and fluid/blood product administration were recorded in real time. Venous waveforms were analyzed into a NIVA value and then correlated, along with mean arterial pressure (MAP), to volume changes. Concordance was quantified to determine if the direction of change in volume was similar to the direction of change in MAP or change in NIVA.ResultsOf 18 patients enrolled, 14 had usable venous waveforms, and there was a significant correlation between change in NIVA value and change in volume. Change in MAP did not correlate with change in volume. The concordance between change in MAP and change in volume was less than the concordance between change in NIVA and change in volume.ConclusionNIVA values correlate more closely to intravascular volume changes in pediatric craniofacial patients than MAP. This initial study suggests that NIVA is a potential safe, reliable, non-invasive quantitative method of measuring intravascular volume changes for children undergoing surgery.
Highlights
In pediatric patients, reliable determination of intravascular volume status can be challenging, as changes in vital signs often do not occur until significant blood loss and end-organ damage have ensued [1, 2]
Concordance was quantified to determine if the direction of change in volume was similar to the direction of change in mean arterial pressure (MAP) or change in Non-Invasive Venous waveform Analysis (NIVA)
The concordance between change in MAP and change in volume was less than the concordance between change in NIVA and change in volume
Summary
Reliable determination of intravascular volume status can be challenging, as changes in vital signs often do not occur until significant blood loss and end-organ damage have ensued [1, 2]. The Pediatric Perioperative Cardiac Arrest Registry reports that under-resuscitation of hemorrhage is one of the principal causes of perioperative death in children [5, 6]. Complex cranial vault reconstruction is performed in children with craniosynostosis and is associated with extensive blood loss, potential life-threatening risks, and significant morbidity. In this preliminary study, we hypothesized that NIVA will provide a reliable, non-invasive, quantitative assessment of intravascular volume changes in children undergoing complex cranial vault reconstruction
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