title: Comparison of monitoring performance of bioreactance versus esophageal Doppler in pediatric patients.
abstract: OBJECTIVE
  Cardiac output (CO) monitoring and goal-directed therapy during major abdominal surgery is currently used to decrease postoperative complications. However, few monitors are currently available for pediatric patients. Nicom(®) is a noninvasive CO monitoring technique based on the bioreactance principle (analysis of frequency variations of a delivered oscillating current traversing the thoracic cavity). Nicom(®) may be a useful monitor for pediatric patients.
  
  
  METHODS
  Pediatric patients undergoing major abdominal surgery under general anesthesia with cardiac monitoring by transesophageal Doppler (TED) were included. Continuously recorded hemodynamic variables obtained from both bioreactance and TED were compared. Data were analyzed using the Bland-Altman method.
  
  
  RESULTS
  A total of 113 pairs of cardiac index (CI) measurments from 16 patients were analyzed. Mean age was 59 months (95% CI: 42-75) and mean weight was 17 kg (95% CI: 15-20). In the overall population, Bland-Altman analysis revealed a bias of 0.4 L/min/m(2), precision of 1.55 L/min/m(2), limits of agreement of -1.1 to 1.9 L/min/m(2) and a percentage error of 47%. For children weighing >15 kg, results were: Bias 0.51 L/min/m(2), precision 1.17 L/min/m(2), limits of agreement -0.64 to 1.66 L/min/m(2) and percentage error 34%.
  
  
  CONCLUSIONS
  Simultaneous CI estimations made by bioreactance and TED showed high percentage of errors that is not clinically acceptable. Bioreactance cannot be considered suitable for monitoring pediatric patients.
authors.affiliation: Départment of Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Dubost
authors.affiliation: Surgical Intensive Care Unit, Institut of Cardiology, Groupe Hospitalier Pitié-Salpêtrière, Réanimation Médicale Polyvalente, Paris, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Bouglé
authors.affiliation: Départment of Anesthésie-Réanimation, Hôpital Saint-Antoine, Paris, France.
authors.forename: Calliope
authors.initials: C
authors.lastname: Hallynck
authors.affiliation: Départment of Anesthésie-Réanimation, Hôpital Lariboisière, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Le Dorze
authors.affiliation: Départment Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Roulleau
authors.affiliation: Départment Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Baujard
authors.affiliation: Départment Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Benhamou
keywords: Cardiac bioreactance; cardiac index; pediatric patients; perioperative monitoring