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Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease
Jessica N Persson1,2, Jacqueline Holstein3, Lori Silveira1
1Department of Pediatrics, University of Colorado Anschutz, Aurora, CO, United States.
Insights
Point-of-care ultrasound reliably measures skin edema in infants after cardiac surgery. This method can objectively assess fluid overload, aiding clinical management in neonates and infants.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Medical Imaging
Background:
- Fluid overload is a significant post-operative complication in pediatric cardiac surgery, linked to higher morbidity and mortality.
- Current methods for assessing fluid status lack a gold standard, necessitating objective evaluation tools.
Purpose of the Study:
- To validate point-of-care ultrasound for measuring skin edema in infants post-cardiac surgery.
- To evaluate the intra- and inter-user variability of this ultrasound technique.
Main Methods:
- Prospective cohort study including neonates and infants undergoing cardiac surgery, plus neonatal controls.
- Skin ultrasound measurements of subcutaneous tissue depth at four body sites, from baseline through post-operative day 3.
- Intraclass correlation coefficient (ICC) used to assess measurement variability.
Main Results:
- Skin edema, indicated by increased subcutaneous tissue, was observed starting post-operative day 1 in neonates, persisting through day 3.
- A similar, though less pronounced, pattern was seen in infants, with near resolution by post-operative day 3.
- Excellent intra-user (ICC 0.95) and very good inter-user (ICC 0.82) variability confirmed the method's reproducibility.
Conclusions:
- Point-of-care skin ultrasound is a reproducible and reliable method for assessing subcutaneous tissue and detecting skin edema in infants.
- This technique offers an objective approach to quantifying extravascular fluid overload in pediatric cardiac surgery patients.
- Further studies are warranted to correlate ultrasound-detected fluid overload with clinical outcomes.
Abstract:
Purpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in infants and assess the intra- and inter-user variability. Methods: Prospective cohort study of neonates (≤30 d/o) and infants (31 d/o to 12 m/o) undergoing cardiac surgery and neonatal controls. Skin ultrasound was performed on four body sites at baseline and daily post-operatively through post-operative day (POD) 3. Subcutaneous tissue depth was manually measured. Intra- and inter-user variability was assessed using intraclass correlation coefficient (ICC). Results: Fifty control and 22 surgical subjects underwent skin ultrasound. There was no difference between baseline surgical and control neonates. Subcutaneous tissue increased in neonates starting POD 1 with minimal improvement by POD 3. In infants, this pattern was less pronounced with near resolution by POD 3. Intra-user variability was excellent (ICC 0.95). Inter-user variability was very good (ICC 0.82). Conclusion: Point-of-care skin ultrasound is a reproducible and reliable method to measure subcutaneous tissue in infants with and without congenital heart disease. Acute increases in subcutaneous tissue suggests development of skin edema, consistent with extravascular fluid overload. There is evidence of skin edema starting POD 1 in all subjects with no substantial improvement by POD 3 in neonates. Point-of-care ultrasound could be an objective way to measure extravascular fluid overload in infants. Further research is needed to determine how extravascular fluid overload correlates to clinical outcomes.
