Noninvasive hemodynamic monitoring in critically ill children – USCOM.
Prospective observational study

Czech version

Authors: J. Fremuth; J. Kobr; L. Šašek; K. Pizingerová; J. Zamboryová; J. Sýkora
Authors‘ workplace: Dětská klinika, Univerzita Karlova v Praze, Lékařská fakulta a Fakultní nemocnice v Plzni přednosta prof. MUDr. J. Sýkora, Ph. D.
Published in: Čes-slov Pediat 2016; 71 (5-6): 260-267.
Category: Original Papers

Overview

Introduction:
Cardiopulmonary interactions influence cardiac output during mechanical ventilation. There is limited prospective data investigating these interactions in critically ill pediatric patients.

Methods:
We performed a prospective observational study to evaluate the influence of mechanical ventilation strategy on hemodynamic changes using ultrasound cardiac output monitoring (USCOM). This study was conducted with 56 children on protective mechanical ventilation for pulmonary (36 children) and non-pulmonary (20 children) pathology. Circulatory parameters (e.g., cardiac index and systemic vascular resistance index) were evaluated after initiation of mechanical ventilation and at 6, 12 and 48-hour intervals. The circulatory support therapy was indicated based on USCOM measurement results. Fluid balance was monitored.

Results:
No signiﬁcant differences between the groups’ hemodynamic profiles were found. Children ventilated for pulmonary pathology tended to require more frequent inotropic and combined inotropic/vasopressor circulatory support than did the children ventilated for non-pulmonary pathology. Children ventilated for non-pulmonary pathology tended to require more frequent vasopressor circulatory support after the initiation of mechanical ventilation. Both groups required a similar amount of fluid during the study.

Conclusion:
The protective strategy of mechanical ventilation was not associated with significant differences in hemodynamic profiles between patients with pulmonary and non-pulmonary pathologies. Although not statistically significant, a trend was observed toward a more frequent requirement for inotropic and combined inotropic/vasopressor therapy in children ventilated for pulmonary pathology, compared to those ventilated for non-pulmonary pathology.

Key words:
USCOM, hemodynamics, cardiopulmonary, children

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