Cardiac output assessed by non-invasive monitoring is associated with ECG changes in children with critical asthma

Abstract

The primary aim of this study was to determine changes in CI and SI, if any, in children hospitalized with status asthmatics during the course of treatment as measured by non-invasive EC monitoring. The secondary aim was to determine if there is an association between Abnormal CI (defined as <5 or >95 % tile adjusted for age) and Abnormal ECG (defined as ST waves changes) Non-invasive cardiac output (CO) recordings were obtained daily from admission (Initial) to discharge (Final). Changes in CI and SI measurements were compared using paired t tests or 1-way ANOVA. The association between Abnormal CI on Initial CO recording and Abnormal ECG was analyzed by Fischer's exact test. Data are presented as mean ± SEM with mean differences reported with 95 % confidence interval; p < 0.05 was considered significant. Thirty-five children with critical asthma were analyzed. CI decreased from 6.2 ± 0.2 to 4.5 ± 0.1 [-1.6 (-0.04 to -0.37)] L/min/m(2) during hospitalization. There was no change in SI. There was a significant association between Abnormal Initial CI and Abnormal ECG (p = 0.02). In 11 children requiring prolonged hospitalization CI significantly decreased from 7.2 ± 0.5 to 4.0 ± 0.2 [-3.2 (-4.0 to -2.3)] L/min/m(2) and SI decreased from 51.2 ± 3.8 to 40.3 ± 2.0 [-11.0 (-17.6 to -4.4)] ml/beat/m(2) There was a significant decrease in CI in all children treated for critical asthma. In children that required a prolonged course of treatment, there was also a significant decrease in SI. Abnormal CI at Initial CO recording was associated with ST waves changes on ECG during hospitalization. Future studies are required to determine whether non-invasive CO monitoring can predict which patients are at risk for developing abnormal ECG.

Continuous noninvasive cardiac output in children: is this the next generation of operating room monitors? Initial experience in 402 pediatric patients

“…This device estimates CO, CI, stroke volume (SV), SI, and a variety of other cardiac parameters using a complex mathematical algorithm (electrical velocimetry relates the maximum rate of change of impedance to peak aortic blood acceleration during the cardiac cycle) with the simple application of four EKG electrodes . The accuracy of this monitor has been validated and compared with other measures of CO such as the Fick equation , thermodilution , and echocardiography in diverse pediatric populations including patients with congenital heart disease and critical illness , neonates , and obese adolescents . One study of patients who had recovered from critical illness demonstrated a bias toward underestimation of CI and another found it to be useful in patients who had undergone cardiac surgery .…”

Takotsubo Syndrome: Still Graveyard of Case Reports?

“…When the high rate (87%) of patients having reduced LV ejection fraction (EF) in the setting of TTS is taken into account, less than half of the patients (47%) presenting with dyspnea may seem relatively low. Nevertheless, this discrepancy is supported by the fact that patients with TTS frequently have a benign course despite losing >50% functional left ventricular myocardium while a patient with ACS faces death in loss of a similar sized portion of LV myocardium [5,17]. Nonetheless, it should be noted that in-hospital death rates are similar between patients with TTS and ACS.…”

Year in review in journal of clinical monitoring and computing 2014: cardiovascular and hemodynamic monitoring

“…Wong and colleagues in the same edition provided a more clinical report of cardiac output monitoring being used to study the progress of children admitted to a hospital for treatment of acute asthma [13]. The cardiac output monitor used was the Aesculon, or portable version the Icon (Cardiotronic Inc., La Jolla, CA, USA) a hybrid bioimpedance device.…”