Prediction of fluid responsiveness using a non-invasive cardiac output monitor in children undergoing cardiac surgery.
BACKGROUND
This study evaluated the ability of a non-invasive cardiac output monitoring device (NICOM) to predict fluid responsiveness in paediatric patients undergoing cardiac surgery.


METHODS
Children aged <5 yr undergoing congenital heart surgery were included. Once the sternum had been closed after repair of the congenital heart defect, 10 ml kg(-1) colloid solution was administered for volume expansion. Transoesophageal echocardiography (TOE) was performed to measure stroke volume (SV) and respiratory variation in aortic blood flow peak velocity (ΔV(peak)) before and after volume expansion. Haemodynamic and NICOM variables, including SV(NICOM), stroke volume variance (SVV(NICOM)), cardiac index (CI(NICOM)), and percentage change in thoracic fluid content compared with baseline (TFCd0%), were also recorded. Patients in whom the stroke volume index (SVI), measured using TOE, increased by >15% were defined as fluid responders.


RESULTS
Twenty-nine patients were included (13 responders and 16 non-responders). Before volume expansion, only ΔV(peak) differed between groups (P=0.036). The SVV(NICOM), HR, and central venous pressure did not predict fluid responsiveness, but ΔV(peak) did. The CI(NICOM) was not correlated with CI(TOE) (r=0.107, P=0.43). Using Bland-Altman analysis, the mean bias between CI(TOE) and CI(NICOM) was 0.89 litre min(-1) m(-2), with a precision of 1.14 litre min(-1) m(-2). Trending ability of NICOM for SVI and CI was poor when TOE was a reference method.


CONCLUSIONS
The SVV(NICOM) did not predict fluid responsiveness in paediatric patients during cardiac surgery. In addition, there was no correlation between CI(TOE) and CI(NICOM). Fluid management guided by NICOM should be performed carefully.


BACKGROUND
ClinicalTrials.gov NCT01996956.
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, # 101 Daehakno, Jongnogu, Seoul 110-744, Republic of Korea.
J-H
JH
Lee
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, # 101 Daehakno, Jongnogu, Seoul 110-744, Republic of Korea.
H-J
HJ
No
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, # 101 Daehakno, Jongnogu, Seoul 110-744, Republic of Korea.
I-K
IK
Song
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, # 101 Daehakno, Jongnogu, Seoul 110-744, Republic of Korea.
H-S
HS
Kim
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, # 101 Daehakno, Jongnogu, Seoul 110-744, Republic of Korea.
C-S
CS
Kim
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, # 101 Daehakno, Jongnogu, Seoul 110-744, Republic of Korea kimjintae73@dreamwiz.com.
J-T
JT
Kim
D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology*; D006348:Cardiac Surgical Procedures; D002496:Central Venous Pressure / Q000502:physiology; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D005440:Fluid Therapy; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D013318:Stroke Volume / Q000502:physiology
cardiac output; cardiac surgical procedure; fluid therapy; paediatrics; stroke volume