Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography

Noori, Shahab; Drabu, Benazir; Soleymani, Sadaf; Seri, István

doi:10.1136/fetalneonatal-2011-301090

Cited by 126 publications

(148 citation statements)

References 15 publications

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“…Noori et al [6] conducted a validation study based on 20 term infants and 8 of them had a PDA >2 mm. He found that EC was as accurate in measuring CO as Echo, and there was no difference in bias and precision between those with or without a hsPDA.…”

Section: Discussionmentioning

confidence: 99%

“…By using transthoracic Echo, the accuracy of EC in term [6,7] and even preterm neonates [8,9,10,11] has been described. It has been studied in different clinical scenarios including surgical ligation for patent ductus arteriosus (PDA) [12], hemodynamic transition after birth [13], caffeine administration [14], and umbilical cord milking in preterm infants [15].…”

Section: Introductionmentioning

confidence: 99%

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Electrical Cardiometry to Monitor Cardiac Output in Preterm Infants with Patent Ductus Arteriosus: A Comparison with Echocardiography

Hsu¹,

et al. 2017

Neonatology

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Background: Electrical cardiometry (EC) is an impedance-based monitoring that provides noninvasive cardiac output (CO) assessment. Through comparison to transthoracic echocardiography (Echo), the accuracy of EC has been verified. However, left-to-right patent ductus arteriosus (PDA) shunting is a concern because PDA shunts aortic flow to the pulmonary artery and may interfere with EC in measuring CO. Objective: To determine the agreement between EC and Echo in preterm infants with a hemodynamically significant PDA (hsPDA). Methods: We reviewed our hemodynamic database in which simultaneous CO measurements by Echo and EC (Aesculon®) were recorded. Preterm infants with left-to-right shunting hsPDA were enrolled. Results: A total of 105 paired measurements in 36 preterm infants were compared. Infants' median (range) age and weight at measurement were 27⁺² weeks (24⁺⁰-33⁺¹) and 1,015 g (518-1,880), with mean (95% CI) ductal diameter 2.11 mm (1.99-2.22) or 2.15 mm/kg (2.00-2.30). Mean CO_EC and CO_Echo were 252 ± 32 and 258 ± 45 mL/kg/min, respectively, which demonstrated a moderate correlation and without a significant between-measurement difference. Bland-Altman analysis showed a bias, limits of agreement, and error percentage of -5.3 mL/kg/min, -78.3 to 67.7 mL/kg/min, and 28.6%, respectively. There was a trend of increased bias and error percentage of infants with high CO ≥280 mL/kg/min and supported with high-frequency ventilator. Conclusions: EC and Echo have a wide but clinically acceptable agreement in measuring CO in preterm infants with hsPDA. However, for infants with high CO or ventilated by high-frequency ventilation, interpretation of CO_EC should be approached with caution.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electrical Cardiometry to Monitor Cardiac Output in Preterm Infants with Patent Ductus Arteriosus: A Comparison with Echocardiography

Hsu¹,

et al. 2017

Neonatology

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“…It is not possible to evaluate the proportion of infants where treatment was initiated or withheld based on low blood pressure values, but it is likely that NIRS monitoring influenced treatment strategies. Non-invasive cardiac output monitoringis a relatively simple, non-invasive monitoring tool that provides continuous estimation of cardiac output and it has been evaluated against simultaneous echo measures of left ventricular output [26,27,28,29]. Future trials are warranted to assess the benefit of this additional assessment tool in preterm infants with low blood pressure.…”

Section: Has Management Changed?mentioning

confidence: 99%

What Should We Do about Low Blood Pressure in Preterm Infants

Dempsey¹

2017

Neonatology

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The management of preterm infants with low blood pressure soon after birth remains unresolved. The definition of what constitutes low blood pressure is uncertain. At birth, mean blood pressure appears to be gestation specific and increases in the first few days of life. Antenatal steroids, delayed cord clamping, and the avoidance of mechanical ventilation are all associated with higher mean blood pressure and less hypotension after birth. Rates of hypotension of 15-50% have been reported in various studies of extremely preterm infants. However, only about 10% of all extremely preterm infants receive inotropes, suggesting that clinicians take into account other factors such as clinical, biochemical, and echocardiographic findings before deciding to intervene. The exact role of functional echocardiography in assessing the need for treatment of low blood pressure in extremely preterm infants remains to be determined. Near- infrared spectroscopy to assess cerebral perfusion may also have a role to play. Volume expansion (usually 10 mL/kg of saline) remains the most commonly used intervention for low blood pressure but evidence of benefit is lacking and there may be safety concerns. Whilst dopamine is the most commonly used inotropic drug, dobutamine, epinephrine, corticosteroids, milrinone, and vasopressin have also been utilised in preterm infants with low blood pressure. Clinical trials with long-term outcomes are needed to determine the most suitable inotrope and when to use it. Early hypotension differs from late hypotension with regard to cause, treatment, and outcome. A number of recent studies aimed at improving the evidence base for the treatment of early hypotension in extremely preterm infants have been terminated early because of poor recruitment. Currently, the answer to the question of what to do about low blood pressure in preterm infants remains unclear.

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“…Preliminary data show a good agreement (bias), but a wide variation (precision) between the average left ventricular output measured by echocardiography and IEC. 31 Thus, the clinical utility of IEC in the assessment of CO in neonates will hinge on the findings of ongoing studies looking at the tightness of the agreement in the direction of CO changes between echocardiography and IEC when different treatment modalities are applied in neonates to affect CO (see below).…”

Section: Introductionmentioning

confidence: 99%

“…However, it must be emphasized that, although studies on validation of IEC have been published in the pediatric patient population, 33 it is an ongoing project in the neonatal patient population with only preliminary data available at present. 31 Therefore, as long as validation is not completed and the limitations of the use of IEC to continuously monitor systemic blood flow in neonates have not been clearly identified, the method cannot be used to perform clinical research or guide treatment in neonates with cardiovascular compromise. In addition, further studies are needed to clearly establish the clinical relevance and utility of the use of NIRS in the neonatal patient population.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic monitoring in neonates: advances and challenges

2010

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Continuous, reliable and real-time assessment of major determinants of cardiovascular function in preterm and term neonates has long been an elusive aim in neonatal medicine. Accordingly, aside from continuous assessment of heart rate, blood pressure and arterial oxygen saturation, bedside monitoring of major determinants of cardiovascular function of significant clinical relevance such as cardiac output, systemic vascular resistance, organ blood flow distribution and tissue oxygen delivery and coupling has only recently become available. Without obtaining reliable information on the changes in and interactions among these parameters in the neonatal patient population during postnatal transition and later in the neonatal period, development of effective and less harmful treatment approaches to cardiovascular compromise is not possible. This paper briefly reviews the recent advances in our understanding of developmental cardiovascular physiology and discusses the methods of bedside assessment of cardiovascular function in general and organ perfusion, tissue oxygen delivery and brain function in particular in preterm and term neonates. The importance of real-time data collection and the need for meticulous validation of the methods recently introduced in the assessment of neonatal cardiovascular function such as echocardiography, electrical impedance cardiometry, near infrared spectroscopy, visible light and laser-Doppler technology are emphasized. A clear understanding of the accuracy, feasibility, reliability and limitations of these methods through thorough validation will result in the most appropriate usage of these methods in clinical research and patient care.

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Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography

Abstract: EV is as accurate in measuring LVO as echocardiography and the variation in the agreement between EV and echocardiography among the individual subjects reflects the limitations of both techniques.

Cited by 126 publications

References 15 publications

Electrical Cardiometry to Monitor Cardiac Output in Preterm Infants with Patent Ductus Arteriosus: A Comparison with Echocardiography

Electrical Cardiometry to Monitor Cardiac Output in Preterm Infants with Patent Ductus Arteriosus: A Comparison with Echocardiography

What Should We Do about Low Blood Pressure in Preterm Infants

Hemodynamic monitoring in neonates: advances and challenges

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