Radha Patel, MS
Medical Student
University of the Incarnate Word School of Osteopathic Medicine, United States
Disclosure information not submitted.
Tracy McCallin, MD, FAAP
Dr.
Baylor College of Medicine, United States
Disclosure information not submitted.
Kiran Mainali, Ph.D
Assistant Professor
University of the Incarnate Word, United States
Disclosure information not submitted.
Kelly Jackson, RN
Administrative Director
The Children’s Hospital of San Antonio, United States
Disclosure information not submitted.
Hannah Starke, MD
Medical Resident
The Children’s Hospital of San Antonio, United States
Disclosure information not submitted.
Utpal Bhalala, MD, , FCCM
Pediatric Intensivist, Associate Professor, Research Advisor
Driscoll Children's Hospital
Corpus Christi
Disclosure information not submitted.
Title: Assessing Fluid Responsiveness In Children With Shock Using Noninvasive Monitor
Introduction:
Assessment of fluid responsiveness is essential yet challenging. Our study aims to compare objective hemodynamic data and predict fluid responsiveness using an ICON monitor in children with shock.
Methods:
We conducted a prospective observational study in children presenting with shock to our emergency department (ED) between June 2020 to March 2021. We collected clinical parameters and hemodynamic data such as Cardiac Output (CO), Cardiac Index (CI), Index of Contractility (ICON), Stroke Volume (SV), Stroke Index (SI), Corrected Flow Time (FTC), Systolic Time Ratio (STR), Variation of Index of Contractility (VIC), Stroke Volume Variation (SVV), Systemic Vascular Resistance (SVR) and Thoracic Fluid Content (TFC) using the ICON® monitor before and after fluid boluses in children with shock. We used paired-sample student’s t test to compare pre and post hemodynamic data and Mann-Whitney U-test to compare fluid responders and non-responders. p< 0.05=significant.
Results:
We recorded 42 fluid interventions in 40 patients between June 2020 – March 2021. The median IQR age was 10.56 (4.8, 14.8) years with male: female ratio 1.2:1. There was significant decrease in ΔRR [-1.61(-14.8, 0); p=0.012], ΔDBP [-5.5 (-14.4, 8); p= 0.027], ΔMAP [-2.2 (-11, 2); p=0.018], ΔSVR [-5.8 (-20, 5.2); p=0.025], ΔSTR [-8.39 (-21, 3); p=0.001]. There was significant increase in ΔTFC [6.2 (3.5, 11.4); p=0.01] following FB. We defined fluid responders by an increase in SV by ≥10% after a single fluid bolus of 20ml/kg crystalloid. Among fluid responders vs non responders the ΔHR [-3.7 (-16.6, -0.72) vs 1.32 (-5.1, 9.9); p=0.002], ΔSI [16 (15.8, 24.2) vs -3 (-9, 0.91); p=0.03/1.14e.07], ΔCO [14.2 (4, 23) vs -2.2 (-12.9, 6.2); p=0.006], ΔCI [14.5 (5.2, 23) vs -3.5 (-12.8, 5.6); p =0.003], ΔSVV [-34 (-50, -2.9) vs 25 (-19.5, 83.7); p=0.002], ΔFTC [7.65 (2.6, 9.4) vs 0 (-6, 3.8); p=0.002], ΔSVR [-12.8 (-22.7, -7.7) vs 0 (-12.8, 9.2); p=031], ΔSTR [-19.3 (-24.6, -12) vs -5 (-14.8, 8.8); p =0.03], and ΔICON [16.7 (13.5, 25) vs -9 (-23, 5.1), p=0.003] were significantly different.
Conclusion:
ICON monitor, a non-invasive hemodynamic monitoring using bioimpedance and electrical cardiometry could be a feasible and safe technique to assess fluid responsiveness in critically ill children.