Related Experiment Video
Updated: May 16, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Electrocardiometry for the Management of Pediatric Septic Shock: A Pilot Randomized Controlled Trial
Suman Sudha Moharana1, Lalitha Av2, Santu Ghosh3
1Department of Pediatric Critical Care, IMS and SUM Hospital, Bhubaneswar, India.
Insights
Continuous hemodynamic monitoring using electrocardiometry in pediatric septic shock significantly reduced fluid resuscitation volumes in the initial 6 hours. This advanced monitoring approach also minimized fluid overload risk in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Hemodynamics
- Septic Shock Management
Background:
- Pediatric septic shock requires careful fluid management to avoid under-resuscitation and fluid overload.
- Clinical monitoring alone may lead to suboptimal fluid administration in pediatric septic shock.
- Noninvasive continuous hemodynamic monitoring offers potential for more precise fluid management.
Purpose of the Study:
- To compare resuscitation fluid volumes in pediatric septic shock using continuous hemodynamic monitoring with electrocardiometry versus clinical monitoring alone.
- To evaluate the impact of advanced hemodynamic monitoring on fluid management strategies in pediatric septic shock.
Main Methods:
- Randomized controlled trial conducted in a pediatric intensive care unit.
- 119 children (2 months to 18 years) with sepsis and unresolved shock were randomized.
- Group A received standard clinical monitoring; Group B received electrocardiometry plus clinical monitoring to guide fluid resuscitation and vasoactive therapy.
Main Results:
- Group B (electrocardiometry) received significantly less fluid volume in the first 6 hours (22 ± 9.2 mL/kg) compared to Group A (30 ± 8.2 mL/kg).
- Total fluid administration in the first 24 hours was lower in Group B (46 ±10.7 mL/kg) versus Group A (56 ±13 mL/kg).
- Group B showed earlier vasoactive therapy initiation and a lower fluid overload percentage (1.7% vs. 2.98%).
Conclusions:
- Continuous hemodynamic monitoring with electrocardiometry promotes a more restrictive fluid strategy in pediatric septic shock.
- This advanced monitoring approach effectively minimizes the risk of fluid overload in critically ill children.
- While fluid management improved, key outcomes like shock resolution and mortality were not significantly different between groups.
Objectives:
To evaluate the difference in the resuscitation fluid volume in the initial 6 hours in pediatric septic shock between those undergoing noninvasive continuous hemodynamic monitoring with electrocardiometry in addition to clinical monitoring vs. clinical monitoring alone.
Design:
Randomized control trial.
Setting:
PICU in a tertiary care hospital.
Patients:
Children from 2 months to 18 years with sepsis and unresolved shock after the initial fluid bolus (FB).
Interventions:
Children were randomized to one of the two groups, that is, electrocardiometry with clinical monitoring group (group B) and clinical monitoring alone group (group A). In group B, electrocardiometry variables (cardiac index and systemic vascular resistance index) along with clinical monitoring were used to guide FB, as well as selection and titration of vasoactive agents. Clinical parameters were used to initiate and titrate fluid resuscitation and vasoactive therapy in group A as per standard guidelines.
Measurements And Main Results:
One hundred nineteen children were enrolled in the study: 60 in group A and 59 in group B. There was a significantly higher requirement for resuscitation fluid volume (mean ± sd) within the initial 6 hours in the group A (30 ± 8.2 mL/kg) as compared with group B (22 ± 9.2 mL/kg). Similarly, maintenance along with resuscitation fluid volume (mean ± sd) administration (56 ±13 vs. 46 ±10.7, p < 0.001) was higher in group A in the first 24 hours of enrollment. Vasoactive therapy initiation was earlier in group B as compared with group A (37 ± 10.14 vs. 47.33 ± 12.41 min) with lower fluid overload percentage (2.98% vs. 1.7%) in this group. However, there was no difference in time to shock resolution, 28-day ICU-free days, hospital-free days, and mortality.
Conclusions:
Advanced hemodynamic monitoring with electrocardiometry along with clinical assessment led to a restrictive fluid strategy in addition to minimizing the risk of fluid overload.
More Related Videos
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
