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.

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.

scholarly journals IV Paracetamol for closure of patent ductus arteriosus in preterm neonates admitted to a tertiary care centre

2018 ◽  
Vol 5 (2) ◽  
pp. 294 ◽  
Author(s):  
Sunil B. ◽  
Shruthi Patel ◽  
Girish N.
Keyword(s):  
Side Effects ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Treatment Options ◽  
Tertiary Care ◽  
Current Treatment ◽  
Preterm Neonates ◽  
Tertiary Care Centre ◽  
Vascular Connection ◽  
Intravenous Paracetamol

Background: Ductus arteriosus is a vascular connection between the pulmonary artery and descending aorta. The incidence is inversely related to birth weight and gestational age (GA). In preterm infants it varies between 40% and 60% on the third day of life. At present, the choice of treatment of clinically significant PDA is with either ibuprofen or indomethacin, but they carry many contraindications and potential side effects. Hence it is important to consider that paracetamol may be used as an alternative to other non steroidal anti-inflammatory drugs and is effective in ductal closure with minimal side effects.Methods:Thirty six preterm infants with hemodynamically significant PDA(hs-PDA) were treated with intravenous paracetamol and subsequent closure was evaluated clinically and by follow-up 2D-Echo.Results: PDA closure following intravenous paracetamol was evident in 27 babies (75%). There were no significant side effects noted with paracetamol therapy.Conclusions: This study shows that paracetamol could offer favourable safety profile in comparison to current treatment options. Therefore, paracetamol may be accepted as a first-line drug treatment for PDA in preterm infants. 

scholarly journals CYP2C9*2 is associated with indomethacin treatment failure for patent ductus arteriosus

2019 ◽  
Vol 20 (13) ◽  
pp. 939-946
Author(s):  
Sydney R Rooney ◽  
Elaine L Shelton ◽  
Ida Aka ◽  
Christian M Shaffer ◽  
Ronald I Clyman ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Treatment Failure ◽  
Preterm Infants ◽  
Gestational Age ◽  
Genetic Factors ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Multicenter Cohort Study ◽  
Patent Ductus ◽  
Indomethacin Treatment

Aims: To identify clinical andgenetic factors associated with indomethacin treatment failure in preterm neonates with patent ductus arteriosus (PDA). Patients & Methods: This is a multicenter cohort study of 144 preterm infants (22–32 weeks gestational age) at three centers who received at least one treatment course of indomethacin for PDA. Indomethacin failure was defined as requiring subsequent surgical intervention. Results: In multivariate analysis, gestational age (AOR 0.76, 95% CI 0.60–0.96), surfactant use (AOR 9.77, 95% CI 1.15–83.26), and CYP2C9*2 (AOR 3.74; 95% CI 1.34–10.44) were each associated with indomethacin failure. Conclusion: Age, surfactant use, and CYP2C9*2 influence indomethacin treatment outcome in preterm infants with PDA. This combination of clinical and genetic factors may facilitate targeted indomethacin use for PDA.

scholarly journals Baseline cardiac output and its alterations during ibuprofen treatment for patent ductus arteriosus in preterm infants

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kai-Hsiang Hsu ◽  
Tai-Wei Wu ◽  
I-Hsyuan Wu ◽  
Mei-Yin Lai ◽  
Shih-Yun Hsu ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Patent Ductus

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

Neonatology ◽  
2017 ◽  
Vol 112 (3) ◽  
pp. 231-237 ◽  
Author(s):  
Kai-Hsiang Hsu ◽  
Tai-Wei Wu ◽  
I-Hsyuan Wu ◽  
Mei-Yin Lai ◽  
Shih-Yun Hsu ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Electrical Cardiometry ◽  
Patent Ductus

scholarly journals Cardiac Output Evaluation on Septic Shock Patients: Comparison between Calibrated and Uncalibrated Devices during Vasopressor Therapy

2021 ◽  
Vol 10 (2) ◽  
pp. 213
Author(s):  
Paolo Persona ◽  
Ilaria Valeri ◽  
Elisabetta Saraceni ◽  
Alessandro De Cassai ◽  
Fabrizia Calabrese ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cardiac Output ◽  
Volume Expansion ◽  
Transpulmonary Thermodilution ◽  
Percentage Error ◽  
Arterial Waveform ◽  
Polar Plot ◽  
Norepinephrine Infusion ◽  
The Mean ◽  
Trending Ability

There are no reliable, non-invasive methods to accurately measure cardiac output (CO) in septic patients. MostCare (Vytech Health™, Vygon, Padova, Italy), is a beat-to-beat, self calibrated method for CO measurement based on continuous analysis of reflected arterial pressure waveforms. We enrolled 40 patients that were suffering from septic shock and requiring norepinephrine infusion to target blood pressure in order to to evaluate the level of agreement between a calibrated transpulmonary thermodilution device (PiCCO System, Pulsion Medical Systems, Feldkirchen, Germany) and the MostCare system in detecting and tracking changes in CO measurements related to norepinephrine reduction in septic shock patients,. PiCCO was connected to a 5 Fr femoral artery catheter and to a central venous catheter. System calibration was performed with 15 mL of cold saline injection over about 3 s. The MostCare device was connected to the artery catheter to analyze the arterial waveform. Before reducing norepinephrine infusion, the PiCCO system was calibrated, the MostCare waveform was optimized, and the values of the complete hemodynamic profile were recorded (T1). Norepinephrine infusion was then reduced by 0.03 mcg/Kg/min. After 30 min, a new calibration of PiCCO system and a new record on both monitors were performed (T2). Static measurements agreements were assessed using the Bland-Altman test, while trending ability was investigated using polar plot analysis. If volume expansion occurred, then related data were separately analyzed. At T1 mean the CO was 5.38 (SD 0.60) L/min, the mean difference was 0.176 L/min, the limits of agreement (LoA) was +1.39 and −1.04 L/min, and the percentage error (PE) was 22.6%; at T2 the mean CO was 5.44 (SD 0.73) L/min, the mean difference was 0.053 L/min, the LoA was +1.51 and −1.40, and the PE was 27%. After considering the volume expansion between T1 and T2, the mean CO at T1 was 5.39 L/min (SD 0.47), the LoA was +1.09 and −0.78 L/min, and the percentage error (PE) was 17%; at T2 the mean CO was 5.35 L/min (SD 0.81), the LoA was +1.73 and −1.52 L/min, and the PE was 30%. The polar plot diagram seems to confirm the trending ability of MostCare system versus the reference method. In septic patients, when the arterial waveform is accurate, MostCare and PiCCO transpulmonary thermodilution exhibit good agreement even after the reduction of norepinephrine and changes in vascular tone or volume expansion. MostCare could be a rapid to set, reliable, and useful tool to monitor hemodynamic variations in septic patients in emergency contexts where thermodilution methods or other advanced systems are not easily available.

scholarly journals Effect of Steroid during Perioperative Period in Patients with Patent Ductus Arteriosus (PDA) Ligation

2017 ◽  
Vol 5 (1-2) ◽  
pp. 9-14
Author(s):  
Kazi Zahidul Hoque ◽  
Masumul Gani Chowdhury ◽  
Mamun Miah ◽  
Akhand Tanzih Sultana
Keyword(s):  
Treatment Group ◽  
Preterm Infants ◽  
Standard Treatment ◽  
Ductus Arteriosus ◽  
Mean Airway Pressure ◽  
Surgical Ligation ◽  
Pda Ligation ◽  
The Mean ◽  
Standard Treatment Group ◽  
Stress Dose

Background & Objective: Patent ductus arteriosus (PDA) is a common condition in preterm infants and is associated with profound morbidity and mortality. Pharmacotherapy (indomethacin or ibuprofen) is the first choice to close the PDA, but if pharmacological closure is contraindicated or failed, surgical ligation is usually performed. But following surgical ligation of PDA, preterm infants may develop severe hypotension and respiratory failure. Prophylactic stress hydrocortisone (HC) has emerged as a therapy to prevent complications, although its efficacy in reducing postoperative hypotension and oxygenation difficulties has not been rigorously tested. The purpose of this study was to compare the outcomes in preterm infants who received stress HC before their PDA ligation to those who did not (standard treatment group or control). Materials & Methods: This comparative clinical trial was conducted in Dhaka Shishu Hospital (DSH), Dhaka over a period of 15 months between April 2014 to June 2015. A total of 40 infants with a significant PDA and a history of failed medical treatment were included in the study and were divided into two groups (each group having 20 infants) – one receiving stress HC before PDA ligation (Case) and the other did not (Control). Respiratory support, expressed as highest FiO2, highest mean airway pressure and mode of ventilation, was noted as was cardiovascular support including inotropic medication, its dose throughout the preoperative and the postoperative periods. Post-operative cardiovascular and respiratory supports were the main outcome measures which were measured within 72 hours following PDA ligation. Result: At baseline both the study groups were almost similar with respect to their sex, gestational age, birth weight, and age at surgery and prenatal steroid exposure. However, there was more incidence of preoperative steroid exposure in standard treatment group. Urine output was somewhat higher in the standard treatment group compared to the HC group but it was not statistically significant (1.33 vs. 1.21 ml/kg/min, p = 0.205). The mean arterial pressure was higher in the HC group than that in the standard treatment group (92.5 vs. 86.7 mmHg, p = 0.018), but it was clinically insignificant. The study observed that infants who received stress dose HC rarely needed vasopressor support post ligation and their average and highest doses of dopamine were also significantly lower compared to their standard treatment group. The postoperative high-frequency ventilation was more often needed in the standard treatment group, although none in either group needed this support preoperatively. The mean airway pressure was although similar in both groups the highest FiO2 was much less in the HC group. Conclusion: The study concluded that stress dose HC given to preterm infants before surgical ligation of PDA may improve the postoperative cardiorespiratory outcomes. But as the sample size was too small, this finding requires validation by large-scale study. Ibrahim Card Med J 2015; 5 (1&2): 9-14

scholarly journals Estimation of cardiac output variations induced by hemodynamic interventions using multi-beat analysis of arterial waveform: a comparative off-line study with transesophageal Doppler method during non-cardiac surgery

2021 ◽  
Author(s):  
Arthur Le Gall ◽  
Fabrice Vallée ◽  
Jona Joachim ◽  
Alex Hong ◽  
Joaquim Matéo ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Fluid Challenge ◽  
Percentage Error ◽  
Exclusion Zone ◽  
Upper Limits ◽  
Before And After ◽  
Transesophageal Doppler ◽  
Trending Ability ◽  
Arterial Wave Reflection

AbstractMulti-beat analysis (MBA) of the radial arterial pressure (AP) waveform is a new method that may improve cardiac output (CO) estimation via modelling of the confounding arterial wave reflection. We evaluated the precision and accuracy using the trending ability of the MBA method to estimate absolute CO and variations (ΔCO) during hemodynamic challenges. We reviewed the hemodynamic challenges (fluid challenge or vasopressors) performed when intra-operative hypotension occurred during non-cardiac surgery. The CO was calculated offline using transesophageal Doppler (TED) waveform (COTED) or via application of the MBA algorithm onto the AP waveform (COMBA) before and after hemodynamic challenges. We evaluated the precision and the accuracy according to the Bland & Altman method. We also assessed the trending ability of the MBA by evaluating the percentage of concordance with 15% exclusion zone between ΔCOMBA and ΔCOTED. A non-inferiority margin was set at 87.5%. Among the 58 patients included, 23 (40%) received at least 1 fluid challenge, and 46 (81%) received at least 1 bolus of vasopressors. Before treatment, the COTED was 5.3 (IQR [4.1–8.1]) l min−1, and the COMBA was 4.1 (IQR [3–5.4]) l min−1. The agreement between COTED and COMBA was poor with a 70% percentage error. The bias and lower and upper limits of agreement between COTED and COMBA were 0.9 (CI95 = 0.82 to 1.07) l min−1, −2.8 (CI95 = −2.71 to−2.96) l min−1 and 4.7 (CI95 = 4.61 to 4.86) l min−1, respectively. After hemodynamic challenge, the percentage of concordance (PC) with 15% exclusion zone for ΔCO was 93 (CI97.5 = 90 to 97)%. In this retrospective offline analysis, the accuracy, limits of agreements and percentage error between TED and MBA for the absolute estimation of CO were poor, but the MBA could adequately track induced CO variations measured by TED. The MBA needs further evaluation in prospective studies to confirm those results in clinical practice conditions.

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