Non-invasive method for rapid bedside estimation of inotropy: theory and preliminary clinical validation

Smith, Brendan E.; Madigan, Veronica

doi:10.1093/bja/aet118

Cited by 32 publications

(26 citation statements)

References 27 publications

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“…Patients underwent evaluation using the UltraSonic Cardiac Output Monitor (USCOM ® , USCOM Ltd, Coffs Harbour, Australia) within 3 h of admission. USCOM is a non‐invasive Doppler ultrasonic technology for the determination of hemodynamic variables, which combines accuracy, non‐invasiveness, speed of performance and ease of execution – desirable qualities in obstetric studies. A non‐imaging continuous‐wave Doppler transducer is placed at the suprasternal notch to measure transaortic blood flow.…”

Section: Methodsmentioning

confidence: 99%

Preterm delivery and elevated maternal total vascular resistance: signs of suboptimal cardiovascular adaptation to pregnancy?

Valensise

Farsetti

Presti

et al. 2016

Ultrasound in Obstet & Gyne

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Section: Methodsmentioning

confidence: 99%

Preterm delivery and elevated maternal total vascular resistance: signs of suboptimal cardiovascular adaptation to pregnancy?

Valensise

Farsetti

Presti

et al. 2016

Ultrasound in Obstet & Gyne

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“…This incorporates the kinetic energy (blood flow) with the potential energy (change in blood pressure) generated with each beat of the heart. This may be a better measure of contractility and overall heart function, as it controls for variation in the cardiac index in low versus high systemic vascular resistance states26 but still requires further validation.Cardiovascular indices: where Bpmean, mean arterial pressure—central venous pressure in mm Hg; Svol, stroke volume in mL; Vmean, mean velocity in m/s; FT, flow time in milliseconds, and ρ, blood density in kg/m 3 26…”

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confidence: 99%

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confidence: 99%

The effects of malnutrition on cardiac function in African children

et al. 2015

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The Effects of Malnutrition on Cardiac Function in African ChildrenJonathan A. Silverman Chair of the Supervisory Committee: Associate Professor Stephen Hawes Department of Epidemiology Objective:To assess the effect of malnutrition on cardiac function in hospitalized African children. Design:Prospective cross-sectional study. Setting:Public referral hospital in Blantyre, Malawi. Patients:We enrolled 272 stable, hospitalized children ages 6-59 months, with and without WHO-defined severe acute malnutrition. Main outcome measures:Cardiac index, heart rate, mean arterial pressure, stroke volume index, and systemic vascular resistance index were measured by the Ultrasound Cardiac Output Monitor (USCOM, Ltd, NSW, Australia). We used linear regression with generalized estimating equations controlling for age, sex, and anemia. Results:Our primary outcome, cardiac index, was similar between those with and without severe Conclusions:In this largest study to date of cardiac function in malnourished children we found that that cardiac function is preserved in stable, hospitalized subjects. Lower mean arterial pressure and systemic vascular resistance index may indicate that these children are in a hypermetabolic state due to early effects of refeeding. Further study is needed to determine if cardiac function is diminished in unstable malnourished children. ! 5!Background:

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“…[17–19] At the time of completion of operation during congenital heart surgery, accurate quantification of ventricular contractility may help to decide which treatment will be effective in the critical period. Although it has been investigated the usefulness of noninvasive bedside monitoring of ventricular contractility, [20] it remains uncertain to determine ventricular contractility and cardiac output in patients who have defective or distorted heart. During the cardiac surgery, transesophageal echocardiography has been most commonly used to evaluate the surgically corrected structures and function.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

et al. 2016

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The maximum rate of pressure rise (dP/dtmax) in radial artery has been proposed as a noninvasive surrogate of aortic dp/dtmax, reflecting left ventricular (LV) contractility in children. The aim of this study was to investigate relationship between aortic and radial dp/dtmax at weaning from cardiopulmonary bypass (CPB) and usefulness of these indices for estimating postoperative outcomes in pediatric congenital heart surgery.Aortic and radial arterial pressure waveforms were analyzed simultaneously during weaning from CPB in 29 congenital heart surgery. The maximum first derivatives of aortic and radial arterial waveforms were calculated and averaged from 3 consecutive respiratory cycles. We obtained the maximum vasoactive inotropic score during the first 36 postoperative hours, LV ejection fraction, and fractional shortening on transthoracic echocardiography performed within postoperative day 7.A significant difference between aortic and radial dP/dtmax was observed (mean difference 356 mm Hg/s, 44% of averages), and radial dP/dtmax was weakly correlated with aortic dP/dtmax (r =0.373, P = 0.047). Aortic dP/dtmax was significantly associated with the maximum vasoactive inotropic score (P < 0.001), postoperative LV ejection fraction (P = 0.018), and fractional shortening (P = 0.015); however, radial dP/dtmax was not. On Receiver operating characteristic analysis, aortic dP/dtmax had a greater area under the curve than radial dP/dtmax in predicting higher vasoactive inotropic score (0.827 vs 0.673).Immediately after CPB in pediatric congenital heart surgery, radial dP/dtmax may not replace aortic dP/dtmax because of a discrepancy between central and peripheral arterial waveforms. In this critical period, aortic dP/dtmax can be useful to estimate postoperative ventricular function rather than peripherally derived dP/dtmax.

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Non-invasive method for rapid bedside estimation of inotropy: theory and preliminary clinical validation

Abstract: The method clearly identified the two clinical groups with no overlap of data points. The discriminant power of SMII and PKR may offer valuable diagnostic methods and monitoring tools in anaesthesia and critical care. This is the first report of normal ranges for SMII and PKR.

Cited by 32 publications

References 27 publications

Preterm delivery and elevated maternal total vascular resistance: signs of suboptimal cardiovascular adaptation to pregnancy?

Preterm delivery and elevated maternal total vascular resistance: signs of suboptimal cardiovascular adaptation to pregnancy?

The effects of malnutrition on cardiac function in African children

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

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