Noninvasive cardiac output monitoring using bioreactance in pediatric continuous blood purification patients

Abstract

Objective To study the influence of continuous blood purification(CBP) on cardiac output 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 therapy, 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 December 2016.The basic CI was 3.4 (2.4, 6.1) L/(min·m2), basic SVI was 43 (26, 75) ml/(m2·beat). During 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. Key words: Bioreactance; Noninvasive cardiac output monitoring; Continuous blood purification; Children,