title: Noninvasive cardiac output monitoring using bioreactance-based technique in pediatric patients with or without ventricular septal defect during anesthesia: in comparison with echocardiography.
abstract: BACKGROUND
  We evaluated the use of bioreactance-based noninvasive cardiac output (CO) monitoring technique (NICOM(™), CO(NICOM)) in pediatric patients with or without ventricular septal defect (VSD) during anesthesia induction to determine its agreement with the measurements assessed by echocardiography (echo, CO(ECHO)).
  
  
  METHODS
  Twenty-eight pediatric patients with normal heart anatomy (group NHA) and 32 with isolated ventricular septal defects (group VSD) were included in this study. The cardiac output was measured simultaneously in minute-by-minute using NICOM and echo (Simpson's rule) during anesthesia induction and intubation. Linear regression and revised Bland-Altman analyses were performed to evaluate the agreement by comparing the paired CO results. The mean percent error ((CO(ECHO)-CO(NICOM))/CO(ECHO) × 100%) was used to assess the impact of congenital heart disease on the agreement.
  
  
  RESULTS
  The measurements of CO by NICOM and echo techniques were highly correlated in group NHA (γ = 0.96, P < 0.005) and VSD (γ = 0.84, P < 0.005). The mean bias (CO(ECHO) - CO(NICOM)) between the two methods was 0.03 and 0.31 l·min(-1) with the limits of agreement (LOA) -0.29 to +0.35 l·min(-1) and -0.44 to +1.05 l·min(-1), which include 96.9% (31/32) and 89.3% (25/28) of all patients' different data in group NHA and VSD, respectively. The median percent errors were significantly lower at all time points in group NHA than those in group VSD (all P < 0.05).
  
  
  CONCLUSIONS
  In children without heart defects, the CO measured by NICOM shows a good agreement with the echo during anesthesia induction. The NICOM technique underestimates echo although a strong correlation exists between two methods in children with ventricular septal defect.
authors.affiliation: Department of Anesthesiology & Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Sun
authors.forename: Chi
authors.initials: C
authors.lastname: Wu
authors.forename: Jun-Zheng
authors.initials: JZ
authors.lastname: Wu
authors.forename: Shan-Shan
authors.initials: SS
authors.lastname: Wang
authors.forename: Jie
authors.initials: J
authors.lastname: Bai
authors.forename: Ming
authors.initials: M
authors.lastname: Zhu
authors.forename: Yu-Qi
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Ma-Zhong
authors.initials: MZ
authors.lastname: Zhang
mesh_terms: D000758:Anesthesia; D002302:Cardiac Output / Q000502:physiology; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D015203:Reproducibility of Results; D013815:Thermodilution / Q000379:methods
keywords: anesthesia; bioreactance; cardiac output; congenital heart defects; echocardiography; pediatrics