title: Low predictability of three different noninvasive methods to determine fluid responsiveness in critically ill children.
abstract: OBJECTIVE
  To predict fluid responsiveness by noninvasive methods in a pediatric critical care population.
  
  
  METHODS
  Prospective observational clinical trial.
  
  
  METHODS
  PICU in a tertiary care academic hospital.
  
  
  METHODS
  Thirty-one pediatric patients aged from 1 day to 13 years under mechanical ventilation and on catecholamine support.
  
  
  METHODS
  We tested three noninvasive methods to predict fluid responsiveness: an esophageal Doppler system (CardioQ), a pulse contour analysis algorithm system (LiDCOrapid), and respiratory variations in vena cava inferior diameter. Stroke volume index was measured by transthoracic echocardiography before and after fluid challenge to determine fluid responders. Infusion of 10 mL/kg hydroxyethylstarch 130/0.4.
  
  
  RESULTS
  Predictability of fluid responsiveness was only found in Doppler peak velocity of descending aortal blood flow. Increased peak velocity with reduction after fluid bolus was predictive for nonresponding to IV fluid challenge. Sensitivity and specificity of peak velocity were 69% and 73%, respectively. The cut point was set at 135.5 cm/s. The lower the Doppler peak velocity, the higher was the probability for a fluid response. Neither stroke volume variations nor respiratory variations in vena cava inferior diameter during mechanical ventilation were useful in predicting fluid responsiveness in this pediatric patient population. None of the children had abdominal hypertension measured by bladder pressure.
  
  
  CONCLUSIONS
  Dynamic preload variables such as stroke volume variation or respiratory variations in vena cava inferior diameter may not be useful for predicting fluid responsiveness in certain pediatric patient populations. Esophageal Doppler peak velocity was predictive of fluid responsiveness where a target value of more than 135,5 cm/s may be a signal to terminate further fluid challenges. This target value may be different in different age groups, as esophageal Doppler peak velocity varies with age.
authors: 1Department of Anesthesia and Critical Care, Danube Hospital, KAV-Vienna, Vienna, Austria. 2Department of Pediatrics, Pediatric Intensive Care Unit, Danube Hospital, KAV-Vienna, Vienna, Austria. 3Department of Biometry and Clinical Epidemiology, Campus Charité Benjamin Franklin, Charité-Medicine University Berlin, Berlin, Germany. 4Department of Anesthesia and Critical Care, Hanuschkrankenhaus, WGKK, Vienna, Austria.
authors: Thomas
authors: T
authors: Weber
authors: Thomas
authors: T
authors: Wagner
authors: Konrad
authors: K
authors: Neumann
authors: Engelbert
authors: E
authors: Deusch
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001011:Aorta / Q000000981:diagnostic imaging / Q000187:drug effects; D062186:Arterial Pressure / Q000187:drug effects; D001783:Blood Flow Velocity / Q000187:drug effects* / Q000502:physiology; D002395:Catecholamines / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000187:drug effects*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000187:drug effects
chemical_list: D002395:Catecholamines; D006895:Hydroxyethyl Starch Derivatives