Agreement of Cardiac Output Measurements between Bioreactance and Transthoracic Echocardiography in Preterm Infants during the Transitional Phase: A Single-Centre, Prospective Study

Neonatology ◽  
2020 ◽  
Vol 117 (3) ◽  
pp. 271-278 ◽  
Author(s):  
Lizelle Van Wyk ◽  
Johan Smith ◽  
John Lawrenson ◽  
Willem Pieter de Boode
Keyword(s):  
Cardiac Output ◽  
Preterm Infants ◽  
Transthoracic Echocardiography ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Percentage Error ◽  
Preterm Neonates ◽  
Non Invasive ◽  
Left Ventricular Output ◽  
Transitional Phase

<b><i>Introduction:</i></b> Bioreactance cardiac output (CO) monitors are able to non-invasively and continuously monitor CO. However, as a novel tool to measure CO, it must be proven to be accurate and precise. <b><i>Objective:</i></b> To determine the agreement between CO measured with a bioreactance monitor and transthoracic echocardiography-derived left ventricular output parameters in preterm infants. <b><i>Methods:</i></b> This is a prospective observational study in 63 preterm neonates with non-invasive respiratory support, not requiring inotrope support. The infants underwent continuous bioreactance monitoring of CO and stroke volume (SV) and simultaneous transthoracic echocardiography every 6 h until 72 h of life. <b><i>Results:</i></b> The agreement between bioreactance and transthoracic echocardiography, for both SV and CO, was poor. The percentage error was 67.5% for SV and 71.6% for CO. The mean error was 60.4% for SV and 69.8% for CO. Bias was affected by numerous variables. After correcting for time, CO and SV bias were significantly affected by the presence of an open patent ductus arteriosus and the level of CO. <b><i>Conclusion:</i></b> Bioreactance cannot be considered interchangeable with transthoracic echocardiography to measure CO in preterm infants during the transition phase. Agreement between bioreactance and other CO metrics should be assessed before concluding its accuracy or inaccuracy in neonates.

Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring

2019 ◽  
Vol 30 (2) ◽  
pp. 249-255
Author(s):  
Alessia Cappelleri ◽  
Neidin Bussmann ◽  
Susan Harvey ◽  
Phillip T. Levy ◽  
Orla Franklin ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Stroke Volume ◽  
Preterm Infants ◽  
Left Ventricular ◽  
Late Preterm ◽  
Cardiac Output Monitoring ◽  
Late Preterm Infants ◽  
Non Invasive ◽  
Left Ventricular Output ◽  
Output Monitoring

AbstractBackground:There is a paucity of functional data on mid-to-late preterm infants between 30+0 and 34+6 weeks gestation. We aimed to characterise transitional cardiopulmonary and haemodynamic changes during the first 48 hours in asymptomatic mid-to-late preterm infants.Methods:Forty-five healthy preterm newborns (mean ± standard deviation) gestation of 32.7 ± 1.2 weeks) underwent echocardiography on Days 1 and 2. Ventricular mechanics were assessed by speckle tracking-derived deformation, rotational mechanics, tissue Doppler imaging, and right ventricle-focused measures (tricuspid annular plane systolic excursion, fractional area change). Continuous haemodynamics were assessed using the NICOM™ system to obtain left ventricular output, stroke volume, heart rate, and total peripheral resistance by non-invasive cardiac output monitoring.Results:Right ventricular function increased (all measures p < 0.005) with mostly stable left ventricular performance between Day 1 and Day 2. NICOM-derived left ventricular output [mean 34%, 95% confidence interval 21–47%] and stroke volume [29%, 16–42%] increased with no change in heart rate [5%, −2 to 12%]. There was a rise in mean blood pressure [11%, 1–21%], but a decline in total peripheral resistance [−14%, −25 to −3%].Conclusion:Left ventricular mechanics remained persevered in mid-to-late premature infants, but right ventricular function increased. Non-invasive cardiac output monitoring is feasible in preterm infants with an increase in left ventricular output driven by an improvement in stroke volume during the transitional period.

scholarly journals Stroke Volume and Left Ventricular Output in Preterm Infants with Patent Ductus Arteriosus

1990 ◽  
Vol 27 (3) ◽  
pp. 278-281 ◽  
Author(s):  
Wolfgang Lindner ◽  
Monika Seidel ◽  
Hans T Versmold ◽  
Christoph Döhlemann ◽  
Klaus P Riegel
Keyword(s):  
Stroke Volume ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Left Ventricular Output ◽  
Patent Ductus

Bioreactance Cardiac Output Trending Ability in Preterm Infants: A Single Centre, Longitudinal Study

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Lizelle Van Wyk ◽  
Johan Smith ◽  
John Lawrenson ◽  
Carl J. Lombard ◽  
Willem-Pieter de Boode
Keyword(s):  
Cardiac Output ◽  
Longitudinal Study ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Concordance Rate ◽  
Preterm Neonates ◽  
Exclusion Zone ◽  
The Mean ◽  
Trending Ability ◽  
Angular Bias

<b><i>Introduction:</i></b> It is unknown whether bioreactance (BR) can accurately track cardiac output (CO) changes in preterm neonates. <b><i>Methods:</i></b> A prospective observational longitudinal study was performed in stable preterm infants (&#x3c;37 weeks) during the first 72 h of life. Stroke volume (SV) and CO, as measured by BR and transthoracic echocardiography, were compared. <b><i>Results:</i></b> The mean gestational age (GA) was 31.3 weeks and mean birth weight (BW) was 1,563 g. Overall, 690 measurements were analysed for trending ability by 4-quadrant and polar plots. For non-weight-indexed measurements, 377 (54.6%) lay outside the 5% exclusion zone, the concordance rate was poor (77.2%) with a high mean angular bias (28.6°), wide limits of agreement and a poor angular concordance rate (17.4%). Neither GA, BW nor respiratory support mode affected trending data. Patent ductus arteriosus, postnatal age, and CO level had variable effects on trending data. Trending data for 5 and 10% exclusion zones were also compared. <b><i>Conclusion:</i></b> The ability of BR to track changes in CO is not interchangeable with CO changes as measured by echocardiography. BR, as a trend monitor for changes in CO or SV to determine clinical decisions around interventions in neonatology, should be used with caution.

scholarly journals Non-invasive Cardiac Output Monitoring in Neonates

2021 ◽  
Vol 8 ◽  
Author(s):  
Roisin O'Neill ◽  
Eugene M. Dempsey ◽  
Aisling A. Garvey ◽  
Christoph E. Schwarz
Keyword(s):  
Cardiac Output ◽  
Ductus Arteriosus ◽  
Patient Positioning ◽  
Red Blood Cell Transfusion ◽  
Preterm Neonates ◽  
Future Research ◽  
Cardiac Output Monitoring ◽  
Clinical Settings ◽  
Non Invasive ◽  
Output Monitoring

Circulatory monitoring is currently limited to heart rate and blood pressure assessment in the majority of neonatal units globally. Non-invasive cardiac output monitoring (NiCO) in term and preterm neonates is increasing, where it has the potential to enhance our understanding and management of overall circulatory status. In this narrative review, we summarized 33 studies including almost 2,000 term and preterm neonates. The majority of studies evaluated interchangeability with echocardiography. Studies were performed in various clinical settings including the delivery room, patent ductus arteriosus assessment, patient positioning, red blood cell transfusion, and therapeutic hypothermia for hypoxic ischemic encephalopathy. This review presents an overview of NiCO in neonatal care, focusing on technical and practical aspects as well as current available evidence. We discuss potential goals for future research.

Effect of Fentanyl Boluses on Cerebral Oxygenation and Hemodynamics in Preterm Infants: A Prospective Observational Study

Neonatology ◽  
2020 ◽  
Vol 117 (4) ◽  
pp. 480-487
Author(s):  
Souvik Mitra ◽  
M. Ege Babadagli ◽  
Tara Hatfield ◽  
Averie dePalma ◽  
Helen McCord ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Observational Study ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Cerebral Oxygenation ◽  
Left Ventricular ◽  
Oxygen Extraction ◽  
Preterm Neonates ◽  
Tissue Oxygen ◽  
Significant Difference

<b><i>Background:</i></b> Fentanyl is a commonly used off-label medication for pain control and sedation in preterm infants. Yet, the effect of fentanyl on cerebral hemodynamics in preterm neonates remains unexplored. <b><i>Objective:</i></b> To evaluate the effect of a bolus dose of fentanyl on the regional cerebral oxygen saturation (RcSO<sub>2</sub>), cerebral fractional tissue oxygen extraction (cFTOE) and left ventricular output (LVO) as compared with pre-administration baseline in preterm infants. <b><i>Methods:</i></b> This was a prospective observational study conducted in a level III Canadian NICU from September 2017 to February 2019. Preterm infants born &#x3c;37 weeks of gestation and scheduled to receive a fentanyl bolus (1–2 μg/kg/dose) were eligible. Infants with major congenital anomalies, medically unstable and those who had received fentanyl in the previous 48 h were excluded. <b><i>Outcomes:</i></b> The primary outcome was the difference between RcSO<sub>2</sub> measured 5 min prior to and RcSO<sub>2</sub> measured at defined time points after administration of fentanyl. <b><i>Results:</i></b> Twenty-eight infants were enrolled during the study period (median gestational age 28 weeks; interquartile range [IQR] 25–29 weeks; median birth weight 1,035 g [IQR 830–1,292 g]; median age 4 days [IQR 3–7 days]). Mean (±standard deviation) baseline RcSO<sub>2</sub> was 73.6% (±11.8), cFTOE was 21.9 (±11.2) and LVO was 380 (±147) mL/kg/min prior to fentanyl infusion. One-way ANOVA showed no statistically significant difference between baseline and any of the post-fentanyl cerebral oxygenation, tissue oxygen extraction or cardiac output measures (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Administration of fentanyl bolus for procedural pain and sedation was not shown to significantly affect cerebral oxygenation, cerebral tissue oxygen extraction or cardiac output in stable preterm infants.

scholarly journals Feasibility of cardiac output measurements in critically ill patients by medical students

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Geert Koster ◽  
Thomas Kaufmann ◽  
Bart Hiemstra ◽  
Renske Wiersema ◽  
Madelon E. Vos ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critical Care ◽  
Medical Students ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Left Ventricular ◽  
Percentage Error ◽  
Poor Agreement ◽  
Cardiac Output Measurements

Abstract Background Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min−1 with limits of agreement of − 2.6 L min−1 to 2.7 L min−1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624

scholarly journals Comparison of esCCO and transthoracic echocardiography for non-invasive measurement of cardiac output intensive care

2012 ◽  
Vol 109 (6) ◽  
pp. 879-886 ◽  
Author(s):  
B. Bataille ◽  
M. Bertuit ◽  
M. Mora ◽  
M. Mazerolles ◽  
P. Cocquet ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Intensive Care ◽  
Transthoracic Echocardiography ◽  
Non Invasive ◽  
Invasive Measurement
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