Document Detail


Continuous noninvasive monitoring of cardiac performance and tissue perfusion in pediatric trauma patients.
MedLine Citation:
PMID:  16338328     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients. METHODS: Review of all patients entered into a prospective noninvasive monitoring protocol. Cardiac index (CI) was measured using a thoracic bioimpedance device and tissue perfusion was assessed by transcutaneous carbon dioxide (Ptcco(2)) tension and oxygen tension indexed to the fraction of inspired oxygen (Ptco(2)/Fio(2)). Survival probability (SP) was continuously calculated using a stochastic analysis program. RESULTS: There were 45 patients with a total of 953 data sets. The mean age was 11 years (range, 1-16 years) with a mean Injury Severity Score of 24 (+/-16). There was no difference between survivors (n = 32) and nonsurvivors (n = 13) at study entry for heart rate, blood pressure, CI, or pulse oximetry (all P > .05). However, survivors demonstrated higher Ptcco(2) (45 vs 35), higher Ptco(2)/Fio(2) (236 vs 156), and higher predicted SP (89% vs 62%) compared with nonsurvivors at study entry and throughout the monitoring period (all P < .01). For the entire data set, the strongest independent predictors of survival were Ptco(2)/Fio(2) and SP. The area under the receiver operating characteristic curve for mortality prediction was 0.83 for SP and 0.71 for Ptco(2)/Fio(2), compared with 0.6 for heart rate, 0.51 for blood pressure, and 0.53 for CI. Similar hemodynamic patterns were observed for all injury patterns with the exception of those with severe brain injury. CONCLUSIONS: Thoracic bioimpedance and transcutaneous monitoring give critical real-time hemodynamic and tissue perfusion data that can provide early identification of pathologic flow patterns and accurately predict survival.
Authors:
Matthew Martin; Carlos Brown; David Bayard; Demetrios Demetriades; Ali Salim; Ryan Gertz; Kenneth Azarow; Charles C J Wo; William Shoemaker
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  40     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-12     Completed Date:  2006-07-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1957-63     Citation Subset:  IM    
Affiliation:
Division of Trauma and Surgical Critical Care, Los Angeles County Hospital + USC Medical Center, Los Angeles, CA 90033, USA. docmartin2@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Blood Circulation
Carbon Dioxide / analysis
Cardiac Output*
Child
Child, Preschool
Electric Impedance
Female
Hemodynamics*
Humans
Infant
Male
Monitoring, Physiologic*
Oximetry
Oxygen / analysis
Predictive Value of Tests
Prognosis
Regional Blood Flow
Respiratory Function Tests
Severity of Illness Index
Survival Analysis
Wounds and Injuries*
Grant Support
ID/Acronym/Agency:
GM-65619/GM/NIGMS NIH HHS; RR-11526/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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