The Use of Electrical Cardiometry for Continuous Cardiac Output Monitoring in Preterm Neonates: A Validation Study

Song, Richard; Rich, Wade; Kim, J. H.; Finer, Neil N.; Katheria, Anup

doi:10.1055/s-0034-1371707

Cited by 46 publications

(50 citation statements)

References 6 publications

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“…The finding was in line with the study by Song et al [9] that the level of agreement between EC and Echo was decreased in infants with HFV. It is known that invasive ventilation, especially HFV, would decrease LV output in newborn infants [23].…”

Section: Discussionsupporting

confidence: 93%

“…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. Song et al [9] presented 70-paired measurements in 38 preterm infants with hsPDA ≥1.5 mm, and the correlation of CO measured by EC and Echo was independent of the presence of the PDA. Torigoe et al [11] showed preterm infants with hsPDA ≥1.5 mm had a larger bias and error percentage than those with non-hsPDA, but EC was generally interchangeable with Echo.…”

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: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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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“…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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“…One limitation is, however, that measurement tends to be less accurate in cases with massive chest wall fluid or edema. For a patient on high frequency ventilation, the measurement is also more difficult 9) . Large shunt PDA may also interfere with its evaluation of cardiac output.…”

Section: Novel Technologies Of Monitoring Circulation In the Newbornmentioning

confidence: 99%

Assessment of Circulatory Status of the Newborn in the Neonatal Intensive Care Unit

Suzuki

2016

Neonatal Med

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The Use of Electrical Cardiometry for Continuous Cardiac Output Monitoring in Preterm Neonates: A Validation Study

Cited by 46 publications

References 6 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

Assessment of Circulatory Status of the Newborn in the Neonatal Intensive Care Unit

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