Blood pressure and flow in pediatric anesthesia: An educational review

Karlsson, Jacob; Lönnqvist, Per‐Arne

doi:10.1111/pan.14328

Cited by 15 publications

(15 citation statements)

References 36 publications

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“…This is likely an example of the often-underestimated difference between pressure and flow, being that changes in CO are not necessarily reflected as a change in blood pressure. 22 Neither ΔVpeak dAo nor ΔVpeak LVOT showed a significant change following volume expansion in both groups. Previous studies using similar methodologies for fluid responsiveness assessment have shown somewhat conflicting data in this regard with both unchanged and even increased ΔVpeak LVOT after fluid loading.…”

Section: Effect Of Volume Expansionmentioning

confidence: 79%

Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow

Karlsson

Peters

Denault

et al. 2023

Acta Anaesthesiol Scand

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BackgroundThe primary aim of the current study was to investigate the ability of respiratory variations in descending aortic flow, measured with two‐dimensional echo at the suprasternal notch (ΔVpeak dAo), to predict fluid responsiveness in anesthetized mechanically ventilated children. In addition, variations in peak descending aortic flow measured with apical transthoracic echo (ΔVpeak LVOT) were examined for the same properties.MethodsTwenty‐seven patients under general anesthesia were investigated in this prospective observational study. Cardiac output, ΔVpeak dAo, and ΔVpeak LVOT were measured at stable conditions after anesthesia induction. The measurements were repeated after a 10 mL kg−1 fluid bolus. Patients were classified as responders if stroke volume index increased by >15% after fluid bolus. The ability of each parameter to predict fluid responsiveness was assessed using receiver operating characteristic curves.ResultsTwenty‐seven patients were analyzed, mean age and weight 43 months and 16 kg, respectively. Twelve responders and 15 non‐responders were identified. ΔVpeak dAo was significantly higher in the responder group (14%, 95% confidence interval [CI]: 12%–17%) compared to the non‐responder group (11%, 95% CI: 9%–13%) (p = .04) at baseline. Area under the ROC curve for ΔVpeak dAo and ΔVpeak LVOT was 0.73 (95% CI: 0.52–0.89, p = .02) and 0.56 (0.34–0.78, p = .3), respectively. A baseline level of ΔVpeak dAo of >14% predicted fluid responsiveness with a sensitivity of 58% (95% CI: 28%–85%) and specificity of 73% (95% CI: 45%–92%).ConclusionIn mechanically ventilated children, ΔVpeak dAo identified fluid responders with moderate diagnostic power in the current study. ΔVpeak LVOT failed to predict fluid responders in the current study.

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Section: Effect Of Volume Expansionmentioning

confidence: 79%

Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow

Karlsson

Peters

Denault

et al. 2023

Acta Anaesthesiol Scand

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“…We read with great interest the review by Karlsson and colleagues that explored the utility (or lack thereof) of using blood pressure as the target metric for titrating care. 1 We wholeheartedly agree with their concerns regarding blood pressure guided titration. They rightly point out that mean blood pressure is the product of cardiac output and systemic vascular resistance.…”

mentioning

confidence: 72%

Oximetry titrated care: This is the way

Loomba

Flores

2021

Pediatric Anesthesia

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“…Even if normal blood pressure (macro-circulation) is maintained, adequate end-organ perfusion (micro-circulation) [28] is not guaranteed. It is the flow of oxygenated blood through the tissue capillaries, rather than the systemic pressure, that provides oxygen delivery to the tissues [16 ▪ ].…”

Section: Nectarine – the Lessonsmentioning

confidence: 99%

“…Tissue oxygenation is affected by oxygen extraction and oxygen delivery (cardiac output, oxygenation, hemoglobin concentration). Although arterial oxygenation and hemoglobin are directly measured, cardiac output is approximated from the blood pressure and heart rate measurements but requires a constant systemic vascular resistance [16 ▪ ]. Direct measurements of cardiac output using capnodynamic and electrical cardiometry are being studied as noninvasive methods but are not yet widely available in clinical practice [16 ▪ ].…”

Section: Nectarine – the Lessonsmentioning

confidence: 99%

After nectarine: how should we provide anesthesia for neonates?

Bertolizio

Disma

Engelhardt

2022

Current Opinion in Anaesthesiology

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Purpose of reviewNeonates have a high risk of perioperative morbidity and mortality. The NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) investigated the anesthesia practice, complications and perioperative morbidity and mortality in neonates and infants < 60 weeks post menstrual age requiring anesthesia across 165 European hospitals. The goal of this review is to highlight recent publications in the context of the NECTARINE findings and subsequent changes in clinical practice. Recent findingsA perioperative triad of hypoxia, anemia, and hypotension is associated with an increased overall mortality at 30 days. Hypoxia is frequent at induction and during maintenance of anesthesia and is commonly addressed once oxygen saturation fall below 85%. Blood transfusion practices vary widely variable among anesthesiologists and blood pressure is only a poor surrogate of tissue perfusion. Newer technologies, whereas acknowledging important limitations, may represent the currently best tools available to monitor tissue perfusion. Harmonization of pediatric anesthesia education and training, development of evidence-based practice guidelines, and provision of centralized care appear to be paramount as well as pediatric center referrals and international data collection networks.

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Blood pressure and flow in pediatric anesthesia: An educational review

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 15 publications

References 36 publications

Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow

Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow

Oximetry titrated care: This is the way

After nectarine: how should we provide anesthesia for neonates?

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