Perioperative hemodynamic parameters monitored by three noninvasive technologies in children with congenital heart disease: A prospective study

Abstract

This study aims to compare the efficiencies of three noninvasive technologies in monitoring the perioperative hemodynamics of children with congenital heart disease (CHD) including ventricular septal defects with or without atrial septal defects. Three noninvasive technologies included transthoracic echocardiography (TTE), electrical cardiometry (EC), and vasoactive inotropic score (VIS). Parameters included left ventricular ejection fraction (LVEF) and cardiac index (cardiac index monitored by ultrasound, uCI) in TTE, cardiac index (cardiac index monitored by electrical cardiometry, eCI) and systemic vascular resistance index (SVRI) in EC, and VIS. Seventy-four children were eligible. Three types of adverse events (AEs) related to disease activity and prognosis were observed, including cardio-pulmonary resuscitation in five cases (5/74, 6.76%), hypoxic-ischemic brain damage in four cases (4/74, 5.41%) and hemopurification in four cases (4/74, 5.41%). Except for LVEF, eight parameters (VISmax [maximum VIS], VISmea [mean VIS], uCImea [mean uCI], uCImin [minimum uCI], eCImea [mean eCI], eCImin [minimum eCI], SVRImea [mean SVRI], and SVRImin [minimum SVRI]) showed predictive value for any AE (p < 0.05). VISmea, uCImea, and eCImea demonstrated the highest accuracy and linear associations (AUROC > 0.9, p = 0.00). Linear associations also existed between the three groups of parameters and the duration of mechanical ventilation (MV) and the length of stay (LOS) in the intensive care unit (ICU). The duration of MV and the LOS in the ICU increased as VISmea rose, or uCImea and eCImea fell (p < 0.05). LVEF in TTE could not predict any AE (p > 0.05) and not fully reflect the cardiovascular function. Therefore, most parameters obtained in TTE, EC, and VIS can reflect the perioperative hemodynamics of children with CHD, with VISmea, uCImea, and eCImea being most accurate.

Keywords

congenital heart disease / echocardiography / electrical cardiometry / hemodynamics / vasoactive inotropic score

References

[1] Garcia RU, Walters HL, Delius RE, Aggarwal S. Vasoactive inotropic score (VIS) as biomarker of short-term outcomes in adolescents after cardiothoracic surgery. Pediatr Cardiol. 2016; 37(2): 271-277.

[2] Pieri M, Belletti A, Monaco F, et al. Outcome of cardiac surgery in patients with low preoperative ejection fraction. BMC Anesthesiol. 2016; 16(1): 97.

[3] Balderas-Muñoz K, Rodríguez-Zanella H, Fritche-Salazar JF, et al. Improving risk assessment for post-surgical low cardiac output syndrome in patients without severely reduced ejection fraction undergoing open aortic valve replacement. The role of global longitudinal strain and right ventricular free wall strain. Int J Cardiovasc Imag. 2017; 33(10): 1483-1489.

[4] Pérez VJL, Jiménez Rivera JJ, Alcalá Llorente MA, et al. Low cardiac output syndrome in the postoperative period of cardiac surgery. Profile, differences in clinical course and prognosis. The ESBAGA study. Med Intensiva. 2018; 42: 159-167.

[5] Butts RJ, Scheurer MA, Atz AM, et al. Comparison of maximum vasoactive inotropic score and low cardiac output syndrome as markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol. 2012; 33(4): 633-638.

[6] Sanders M, Servaas S, Slagt C. Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis. J Clin Monit Comput. 2020; 34(3): 433-460.

[7] Cecconi M, Corredor C, Arulkumaran N, et al. Clinical review: goal-directed therapy-what is the evidence in surgical patients? The effect on different risk groups. Crit Care. 2013; 17(2): 209.

[8] Sun Y, Chai F, Pan C, Romeiser JL, Gan TJ. Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery-a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2017; 21(1): 141.

[9] Grocott MP, Dushianthan A, Hamilton MA, Mythen M, Harrison D, Rowan K. Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane Systematic Review. Br J Anaesth. 2013; 111(4): 535-548.

[10] Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011; 112(6): 1392-1402.

[11] Pearse RM, Harrison DA, MacDonald N, et al. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014; 311(21): 2181-2190.

[12] Schubert S, Schmitz T, Weiss M, et al. Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput. 2008; 2(4): 299-307.

[13] Tirotta CF, Lagueruela RG, Madril D, et al. Non-invasive cardiac output monitor validation study in pediatric cardiac surgery patients. J Clin Anesth. 2017; 38: 129-132.

[14] Noori S, Drabu B, Soleymani S, Seri I. Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography. Arch Dis Child Fetal Neonatal Ed. 2012; 97(5): F340-F343.

[15] Musick MA, Loftis LL, Kennedy CE. Comparing vasoactive-inotropic score reporting strategies in the PICU relative to mortality risk. Pediatr Crit Care Med. 2018; 19(12): 1130-1136.

[16] Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010; 11(2): 234-238.

[17] Han J, Pinsino A, Sanchez J, et al. Prognostic value of vasoactive-inotropic score following continuous flow left ventricular assist device implantation. J Heart Lung Transplant. 2019; 38(9): 930-938.

[18] Kawai Y, Cornell TT, Cooley EG, et al. Therapeutic plasma exchange may improve hemodynamics and organ failure among children with sepsis-induced multiple organ dysfunction syndrome receiving extracorporeal life support. Pediatr Crit Care Med. 2015; 16(4): 366-374.

[19] Conlon TW, Falkensammer CB, Hammond RS, Nadkarni VM, Berg RA, Topjian AA. Association of left ventricular systolic function and vasopressor support with survival following pediatric out-of-hospital cardiac arrest. Pediatr Crit Care Med. 2015; 16(2): 146-154.

[20] Aziz KB, Lavilla OC, Wynn JL, Lure AC, Gipson D, de la Cruz D. Maximum vasoactive-inotropic score and mortality in extremely premature, extremely low birth weight infants. J Perinatol. 2021; 41(9): 2337-2344.

[21] Dilli D, Akduman H, Orun UA, et al. Predictive value of vasoactive-inotropic score for mortality in newborns undergoing cardiac surgery. Indian Pediatr. 2019; 56(9): 735-740.

[22] Lauritsen J, Gustafsson F, Abdulla J. Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta-analysis. ESC Heart Fail. 2018; 5(4): 685-694.

[23] Abdalaziz FA, Algebaly HAF, Ismail RI, El-Sherbini SA, Behairy A. The use of bedside echocardiography for measuring cardiac index and systemic vascular resistance in pediatric patients with septic shock. Rev Bras Ter Intensiva. 2018; 30(4): 460-470.

[24] Cox PBW, Ouden AMD, Theunissen M, et al. Accuracy, precision, and trending ability of electrical cardiometry cardiac index versus continuous pulmonary artery thermodilution method: a prospective, observational study. BioMed Res Int. 2017; 2017:2635151.

[25] Tomaske M, Knirsch W, Kretschmar O, et al. Evaluation of the Aesculon cardiac output monitor by subxiphoidal Doppler flow measurement in children with congenital heart defects. Eur J Anaesthesiol. 2009; 26: 412-415.

[26] Yoshitake S, Miyamoto T, Tanaka Y, Naito Y. Non-invasive measurement of cardiac output using AESCULON^® mini after Fontan operation. Pediatr Int. 2017; 59(2): 141-144.

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2024 The Author(s). Pediatric Discovery published by John Wiley & Sons Australia, Ltd on behalf of Children's Hospital of Chongqing Medical University.