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Cardiac and vascular findings using ultrasound in hypovolemic children
Rehab Gabr1, Ahmed Al Hazmi1, Nabeel Al Mashraki1
1Paediatric Intensivist, King Fahad Medical City, Riyadh, Saudi Arabia.
Insights
Passive leg raising significantly altered ultrasound measurements in children. While fasting had a minor effect on left ventricle outflow tract Vmax, more research is needed to confirm its use in detecting pediatric hypovolemia.
Area of Science:
- Pediatric Intensive Care
- Cardiovascular Physiology
- Point-of-Care Ultrasound
Background:
- Ultrasound is a valuable non-invasive tool for assessing volume status.
- Early detection of hypovolemia in children is critical for timely intervention.
Purpose of the Study:
- To evaluate the impact of dehydration and passive leg raising on ultrasound-derived cardiac and inferior vena cava parameters.
- To enhance the early detection of hypovolemia in pediatric patients.
Main Methods:
- A prospective observational study was conducted in a tertiary pediatric intensive care unit.
- 66 healthy children (8-14 years) underwent ultrasound measurements pre- and post-fasting, with and without passive leg raising.
- Key parameters included inferior vena cava (IVC) diameter and collapsibility, and left ventricle outflow tract (LVOT) velocity time integral and Vmax.
Main Results:
- Passive leg raising led to increased IVC diameter and decreased IVC collapsibility (p < 0.001).
- Velocity time integral increased with passive leg raising (p < 0.001), but was not significantly affected by fasting (p = 0.17).
- LVOT Vmax increased with passive leg raising and decreased with fasting (p = 0.001).
Conclusions:
- Passive leg raising significantly influences ultrasound measurements in children.
- LVOT Vmax is affected by fasting-induced mild dehydration.
- Further studies are required to validate Vmax's utility in predicting pediatric hypovolemia.
Background:
Ultrasound is a non-invasive tool that helps assess volume status.
Objectives:
To assess the dehydration and passive leg raising impact on ultrasound-derived cardiac and inferior vena cava parameters to improve early detection of hypovolemia in children.
Design:
Prospective observational study in a tertiary paediatric intensive care unit.
Methods:
We recruited 66 healthy children 8-14 years old who fasted in Ramadan. Inferior vena cava diameter, inferior vena cava collapsibility, velocity time integral and maximum velocity (Vmax) were measured at left ventricle outflow tract pre- and post-fasting, with and without passive leg raising. Aorta diameter in systole was also measured pre- and post-fasting.
Outcome Measures:
Inferior vena cava diameter and collapsibility, velocity time integral and Vmax with and without passive leg raising, pre and post fasting, and inferior vena cava/Ao ratio pre and post fasting were measured.
Results:
Median percentage of weight loss after fasting was 1.1% (range, 0%-3.9%). Inferior vena cava maximum diameter and inferior vena cava/aorta did not change significantly after fasting (p < 0.05). Inferior vena cava diameters increased and inferior vena cava collapsibility decreased after passive leg raising (p < 0.001) pre and post fasting. Velocity time integral increased with passive leg raising (p < 0.001) but was not affected by fasting (p = 0.17). Vmax increased with passive leg raising and decreased in fasting (p = 0.001).
Conclusion:
Passive leg raising affected ultrasound measurements. Left ventricle outflow tract Vmax was affected by fasting/mild dehydration, and further trials are needed to confirm its value in predicting hypovolemia in children.
Limitations:
There was no significant effect of dehydration on the measurements probably because of the small sample and mild dehydration. This cannot be generalised because it is a single-centre study and younger children were not included.
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