Noninvasive Static Indices using Trans Thoracic Echocardiography (TTE) Parameters can Predict Fluid Responsiveness in Spontaneously Breathing Patients in Pediatric Intensive Care Unit (PICU)

Background: CO assessment has an important role for the management of children with acute circulatory failure (ACF) in order to improve the hemodynamic status in PICU. In this way CO can be measured noninvasively by intensivist using Echocardiography, This monitoring device tracks the changes in CO induced by volume expansion, vasopressor or inotropic drugs.

Objective: Our aim is to improve hemodynamic status in patients with shock in PICU using CO assessment by echocardiography.

Methods: We conducted a prospective study in our PICU from January 2012 to December 2017. including all children presented ACF. CO and strok volume assessment for each patient with shock using Echocardiography by Intensivist before and after hemodynamic treatment (AHT)

Results: In 145 children, management of ACF using echocardiography showed CO and SV at base line ((2,55±1,33) l / min and (21,7±13,4) ml) respectively, AHT using volume expansion (20,0 ± 5,6 ml/kg) in hypovolemic patients, norepinephrine (NE) increasing dose [(1,33±1,68) vs. (1,27±1,70) μg/kg/min ; p = 0,024] in vasoplegic patients with preload dependency and dobutamine increasing dose [(7.48 4.10) vs. (4.06 4.92) (μg/kg/min); P0,0001] in patients with cardiogenic shock »; hemodynamic status improved showing increased in CO and SV [(2,91±1,56); p<0,0001], [(25,7±15,5) vs.; p<0,0001] respectively, decreased in HR [(122,6±26,2) vs. (127,5±26,5) b/min; p<0,0001] with increased in SAP, DAP and MAP [(104,7±17,5) vs. (98,5±20,1) (mmHg); P<0,0001], [(52,3±11,6) vs. (49,1±13,5) (mmHg); P<0,0001] and [(70,7±16,5) vs. (66,8±15,7) (mmHg); P<0,0001] respectively.

Conclusion: In this study, CO assessment using Echocardiography by Intensivist allows management of shock in children in ICU.