Pressure recording analytical method and bioreactance for stroke volume index monitoring during pediatric cardiac surgery

Garisto, Cristiana; Favia, Isabella; Ricci, Zaccaria; Romagnoli, Stefano; Haiberger, Roberta; Polito, Angelo; Cogo, Paola

doi:10.1111/pan.12360

Cited by 23 publications

(18 citation statements)

References 32 publications

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“…In a recent study, Garisto et al . evaluated the difference between stroke volume index (SVI) measured by PRAM and bioreactance and their ability to track changes after treatment of children undergoing cardiac surgery. They observed that under stable hemodynamic conditions, both methods provided similar SVI estimations, although bioreactance SVI values appeared significantly lower than PRAM after fluid replacement.…”

Section: Discussionmentioning

confidence: 99%

Measuring cardiac output in children undergoing cardiac catheterization: comparison between the Fick method and PRAM (pressure recording analytical method)

Alonso-Íñigo

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Carrasco

et al. 2016

Pediatric Anesthesia

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Section: Discussionmentioning

confidence: 99%

Measuring cardiac output in children undergoing cardiac catheterization: comparison between the Fick method and PRAM (pressure recording analytical method)

Alonso-Íñigo

Escribá

Carrasco

et al. 2016

Pediatric Anesthesia

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“…Bojan and coauthors also hypothesized that cardiopulmonary bypass would have a significantly greater role than low cardiac output on AKI development. It must be acknowledged that no direct measure of cardiac output was included in their study and its assessment is currently poorly applied in the context of pediatric cardiac surgery [11] and pediatric intensive care [12, 13]: it would be interesting to perform a similar analysis including direct cardiac output estimation.…”

Section: Main Textmentioning

confidence: 99%

Latent AKI is… still AKI: the quantification of the burden of renal dysfunction

2016

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The association between pediatric cardiac surgery, acute kidney injury (AKI), and clinical outcomes has been studied several times in the recent literature. In this issue of Critical Care an interesting and original study analyzed the path from causal AKI entities to clinical AKI consequences through the application of structural equation modeling. The authors described the complex connections linking duration of cardiopulmonary bypass, cross clamp-time, and descriptors of low cardiac output syndrome to AKI modeled as a complex variable composed of post-operative serum creatinine increase of 50 % over baseline, urine output <0.5 ml/kg/h, and urine creatinine-normalized neutrophil gelatinase lipocalin within 12 h of surgery. Similarly, the causal relationships between AKI and hard outcomes in the analyzed population were verified and quantified. The authors, for the first time, produce a repeatable coefficient (0.741) that may become a useful quality benchmark and could be applied to test future interventions aiming to reduce the burden of AKI on children’s clinical course.

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“…PIM2 score is utilized in our hospital to assess critical illness severity of children admitted to our pediatric intensive care units (PICUs) (13). Finally, after CPB, CI is routinely monitored at our institution by pressure recording analytical method (PRAM) (14): it is a minimally invasive hemodynamic monitoring system based on mathematical analysis of the invasive arterial waveform recorded at a high sampling rate (1000 Hz). The area under the pressure wave is examined during the whole cardiac cycle, including the postdicrotic notch phase, and it is utilized to assess the patients' stroke index.…”

Section: Evaluated Scores and Hemodynamic Measurementsmentioning

confidence: 99%

“…Median Aristotle score was 8 (6)(7)(8)(9)(10) and VIS, at CPB weaning, was 16 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). In all cases, it was possible to retrieve hemodynamic PRAM data recorded throughout the procedure.…”

Section: Description Of Enrolled Patientsmentioning

confidence: 99%

Multisite Near Infrared Spectroscopy During Cardiopulmonary Bypass in Pediatric Patients

et al. 2015

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Multisite near infrared spectroscopy (NIRS) monitoring during pediatric cardiopulmonary bypass (CPB) has not been extensively validated. Although it might be rational to explore regional tissue saturation at different body sites (namely brain, kidney, upper body, lower body), conflicting results are currently provided by experience in children. The aim of our study was to evaluate absolute values of multisite NIRS saturation during CPB in a cohort of infants undergoing pediatric cardiac surgery to describe average differences between cerebral, renal, upper body (arm), and lower body (thigh) regional saturation. Furthermore, the correlation between cerebral NIRS and cardiac index (CI) at CPB weaning was evaluated. Twenty-five infants were enrolled: their median weight, age, and body surface area were 3.9 (3.3-6) kg, 111 (47-203) days, and 0.24 (0.22-0.33) m(2) , respectively. Median Aristotle score was 8 (6-10), and vasoactive inotropic score at CPB weaning was 16 (14-25). A total of 17 430 data points were recorded by each sensor: two-way ANOVA showed that time (P < 0.0001) and site (P = 0.0001) significantly affected variations of NIRS values: however, if cerebral NIRS values are excluded, sensor site is no more significant (P = 0.184 in the no circulatory arrest [noCA] group and P = 0.42 in the circulatory arrest [CA] group). Analysis of NIRS saturation changes over time showed that, at all sites, average NIRS values increased after CPB start, even if the increase of cerebral saturation was less intense than other sites (P < 0.0001). Detailed analysis of interaction between site of NIRS measurement and time point showed that cerebral NIRS (ranging from 65 to 75%) was always significantly lower than that of other channels (P < 0.0001) that tended to be in the range of oversaturation (80-90%), especially during the CPB phase. Average cerebral NIRS values of patients who did not undergo circulatory arrest (CA) during CPB, 10 min after CPB weaning, were associated with average CI values with a significant correlation (r = 0.7, P = 0.003). In conclusion, during CPB, cerebral NIRS values are expected to remain constantly lower than somatic sensors, which instead tend to show similar elevated saturations, regardless of their position. Based on these results, positioning of noncerebral NIRS sensors during CPB without CA may be questioned.

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Pressure recording analytical method and bioreactance for stroke volume index monitoring during pediatric cardiac surgery

Abstract: Pressure recording analytical method and bioreactance provided similar SVI estimation at stable hemodynamic conditions, while bioreactance SVI values appeared significantly lower than PRAM at the end of CPB and after fluid replacement.

Cited by 23 publications

References 32 publications

Measuring cardiac output in children undergoing cardiac catheterization: comparison between the Fick method and PRAM (pressure recording analytical method)

Measuring cardiac output in children undergoing cardiac catheterization: comparison between the Fick method and PRAM (pressure recording analytical method)

Latent AKI is… still AKI: the quantification of the burden of renal dysfunction

Multisite Near Infrared Spectroscopy During Cardiopulmonary Bypass in Pediatric Patients

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