| Ultrasound dilution: an accurate means of determining cardiac output in children. | |
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MedLine Citation:
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PMID: 21499176 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Cardiac output is a useful measure of myocardial performance. Cardiac output monitoring is frequently performed in critically ill adults to guide physicians' treatment strategies. However, standard methods of determining cardiac output in children are not without risk and can be problematic secondary to their invasive nature and other technical problems. The COstatus system (Transonic Systems, NY), which is based on ultrasound dilution technology, works off in situ catheters and uses an innocuous indicator to allow for routine measurements of cardiac output and blood volumes in pediatric patients. The purpose of this study was to validate cardiac output measured by the COstatus system with those obtained by the clinical standard technique of pulmonary artery thermodilution. METHODS: This was a prospective evaluation performed at a single institution. Any child with a structurally normal heart undergoing hemodynamic evaluation in the cardiac catheterization laboratory was included. A prograde right heart catheterization was performed, and cardiac output was first determined by using the pulmonary artery thermodilution technique. Thermodilution results were then compared with cardiac output measurements obtained using the COstatus system. The results were analyzed by standard correlation, Bland-Altman, and Critchley and Critchley analyses. RESULTS: Twenty-eight patients were evaluated with a median age of 8 yrs and a median weight of 31 kg. The mean thermodilution cardiac index = 3.18 L/min (± 1.35 L/min), and the mean COstatus system cardiac index = 3.17 L/min (± 1.31 L/min). Standard Pearson correlation tests revealed an excellent correlation coefficient of 0.95 (p < .0001). Bland-Altman analysis revealed good clinical agreement with a mean difference of -0.004 L/min with a precision of 0.8 L/min at 2 SD. A percentage error of 25.4% was noticed in this study, which is less than the clinically acceptable limit. CONCLUSION: The ultrasound dilution technique of determining cardiac output using the COstatus system provides a less invasive method than the traditional pulmonary artery thermodilution for accurately determining cardiac output in children. This is the first validation of the COstatus system in pediatric patients. Further studies are required to establish its accuracy in pediatric patients with cardiac shunts and other hemodynamically unstable conditions. |
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Authors:
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Ivory Crittendon; William J Dreyer; Jamie A Decker; Jeffrey J Kim |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Validation Studies |
Journal Detail:
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Title: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Volume: 13 ISSN: 1529-7535 ISO Abbreviation: Pediatr Crit Care Med Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-01-06 Completed Date: 2012-05-09 Revised Date: 2013-05-24 |
Medline Journal Info:
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Nlm Unique ID: 100954653 Medline TA: Pediatr Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 42-6 Citation Subset: IM |
Affiliation:
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Section of Pediatric Cardiology-Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. ivory.crittendon@gmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Cardiac Catheterization / methods Cardiac Output / physiology* Child Child, Preschool Cohort Studies Female Heart Transplantation / methods Humans Infant Male Monitoring, Physiologic / methods* Prospective Studies Pulmonary Artery* Sensitivity and Specificity Thermodilution / instrumentation*, methods Ultrasonography / instrumentation* |
| Grant Support | |
ID/Acronym/Agency:
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R44 HL061994-03/HL/NHLBI NIH HHS; R44 HL061994-05/HL/NHLBI NIH HHS; R44HL061994/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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Pediatr Crit Care Med. 2012 Jan;13(1):99
[PMID:
22222646
]
Pediatr Crit Care Med. 2013 Jan;14(1):116 [PMID: 23295849 ] Pediatr Crit Care Med. 2013 Jan;14(1):115-6 [PMID: 23295848 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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