title: Noninvasive cardiac output measurement using bioreactance in postoperative pediatric patients.
abstract: BACKGROUND
  Thoracic bioreactance is a noninvasive and continuous method of cardiac output (CO) measurement that is being developed in adult patients. Very little information is available on thoracic bioreactance use in children.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the ability of a bioreactance device (NICOM(®) ; Cheetah Medical, Tel Aviv, Israel) to estimate CO and to track changes in CO induced by volume expansion (VE) in children.
  
  
  METHODS
  Cardiac output values obtained using the NICOM(®) device (CONICOM ) and measured by trans-thoracic echocardiography (COTTE ) were compared in pediatric neurosurgical patients during the postoperative period.
  
  
  RESULTS
  Seventy-three pairs of measurements of CO obtained in 30 children were available for analysis. The bias (lower and upper limits of agreement) between CONICOM and COTTE was -0.11 (-1.4 to 1.2) l·min(-1). The percentage error (PE) was 55%. The precision of the NICOM(®) device was 45%. A significant correlation was observed between the CO values obtained using the two methods (r = 0.89, <0.001). The concordance percentage between changes in COTTE and CON icom induced by VE was 84% following exclusion of patients with changes in CO <15% (n = 5).
  
  
  CONCLUSIONS
  The PE observed is too large, and the limits of agreement too wide, to enable us to comment on the equivalence of the two techniques of CO measurements. However, the NICOM(®) device performs well in tracking changes in CO following VE.
authors.affiliation: Service d'Anesthésie Réanimation, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Vergnaud
authors.forename: Charles
authors.initials: C
authors.lastname: Vidal
authors.forename: Juliette Montmayeur
authors.initials: JM
authors.lastname: Verchere
authors.forename: Hanna
authors.initials: H
authors.lastname: Taright
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Meyer
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Carli
authors.forename: Gilles A
authors.initials: GA
authors.lastname: Orliaguet
mesh_terms: D002302:Cardiac Output / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D015203:Reproducibility of Results; D013815:Thermodilution / Q000295:instrumentation / Q000379:methods; D014463:Ultrasonography
keywords: cardiac output; children; equipment; measurement; monitoring; volume expansion