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Determining pediatric fluid responsiveness by stroke volume variation analysis using ICON® electrical cardiometry and

Kurniawan Taufiq Kadafi1, Abdul Latief2, Antonius Hocky Pudjiadi2

  • 1Department of Pediatrics, Division of Pediatric Critical Care, Saiful Anwar General Hospital, University of Brawijaya, Malang, Indonesia.

International Journal of Critical Illness and Injury Science
|January 7, 2021
PubMed

Insights

Electrical cardiometry (ICON) is not adequate for assessing fluid responsiveness in pediatric shock patients. Ultrasonic cardiac output monitor (USCOM) showed better validity for stroke volume variation (SVV) in guiding fluid resuscitation.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hemodynamic Monitoring
  • Fluid Responsiveness Assessment

Background:

  • Assessing fluid responsiveness is crucial in managing pediatric shock.
  • Stroke volume variation (SVV) is a potential non-invasive indicator.
  • Electrical cardiometry (ICON) and ultrasonic cardiac output monitor (USCOM) are used for hemodynamic assessment.

Purpose of the Study:

  • To validate the use of ICON and USCOM for determining fluid responsiveness in mechanically ventilated children in shock.
  • To establish optimal cutoff points for SVV using ICON and USCOM.
  • To identify the cutoff point for tidal volume in predicting fluid responsiveness.

Main Methods:

  • A cross-sectional study involving 45 pediatric patients in shock on mechanical ventilation.
  • SVV and stroke volume (SV) were measured using ICON and USCOM before and after fluid challenge.
  • Tidal volume was recorded for each patient.

Main Results:

  • ICON showed low sensitivity (58%) and specificity (74%) for fluid responsiveness, with an area under the curve (AUC) of 53%.
  • USCOM demonstrated better performance with an AUC of 70% (P < 0.05) for SVV cutoff at 33.5%.
  • Tidal volume cutoff of 6.8 ml/kg BW had poor predictive value (AUC 44.6%, P > 0.05).

Conclusions:

  • Electrical cardiometry (ICON) is inadequate for assessing preload and guiding fluid resuscitation in pediatric shock.
  • USCOM appears more reliable for SVV-based fluid responsiveness assessment in this population.
  • Tidal volume is not a reliable predictor of fluid responsiveness in pediatric shock.
Abstract

Keywords:
ICONstroke volume variationultrasonic cardiac output monitor

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