Kadafi Kurniawan Taufiq, Latief Abdul, Pudjiadi Antonius Hocky
Department of Pediatrics, Division of Pediatric Critical Care, Saiful Anwar General Hospital, University of Brawijaya, Malang, Indonesia.
Department of Pediatrics, Division of Pediatric Critical Care, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
Int J Crit Illn Inj Sci. 2020 Jul-Sep;10(3):123-128. doi: 10.4103/IJCIIS.IJCIIS_87_18. Epub 2020 Sep 22.
The purpose is to determine the adequacy fluid responsiveness by the validity and cut off point of stroke volume variation (SVV) usingelectrical cardiometry, ICON® (Osypka Medical, Berlin, Germany) and ultrasonic cardiac output monitor (USCOM) and to recognize cut off point of tidal volume in shock children with mechanical ventilation.
A cross-sectional study was conducted from March 2017 to September 2017 in a single center. The selection of subject through consecutive sampling. Measurements of SVV and stroke volume (SV) using USCOM and ICON were performed before and after fluid challenge. The tidal volume of individuals was measured and recorded.
Analysis was performed in 45 patients with median age of 14 months and 62.2% of male population. It showed that the sensitivity and specificity of ICON were 58% and 74%, respectively. The optimal cut off point of SVV using ICON was 16.5% and the area under the curve (AUC) value was 53% (95% confidence interval [CI] 35.9%-70%), > 0.05 and cut off point of SVV using USCOM was 33.5% with the AUC value was 70% (95% CI 52.9%-87.7%), < 0.05. The optimal cut off point of tidal volume to fluid responsivenes was 6.8 ml/kg BW and the AUC value was 44.6% (95% CI 27.4%-61.9%), > 0.05.
This study showed that electrical cardiometry (ICON) is unable to assess preload and the response of fluid resuscitation in children.
通过使用心阻抗图仪（ICON®，德国柏林奥西普卡医疗公司）和超声心输出量监测仪（USCOM）测定每搏量变异度（SVV）的有效性和截断点来确定液体反应性是否充足，并识别机械通气的休克儿童的潮气量截断点。
2017年3月至2017年9月在单一中心进行了一项横断面研究。通过连续抽样选择研究对象。在液体冲击前后使用USCOM和ICON测量SVV和每搏量（SV）。测量并记录个体的潮气量。
对45例患者进行了分析，中位年龄为14个月，男性占62.2%。结果显示，ICON的敏感性和特异性分别为58%和74%。使用ICON时SVV的最佳截断点为16.5%，曲线下面积（AUC）值为53%（95%置信区间[CI] 35.9%–70%），>0.05；使用USCOM时SVV的截断点为33.5%，AUC值为70%（95% CI 52.9%–87.7%），<0.05。潮气量对液体反应性的最佳截断点为6.8 ml/kg体重，AUC值为44.6%（95% CI 27.4%–61.9%），>0.05。
本研究表明，心阻抗图仪（ICON）无法评估儿童的前负荷和液体复苏反应。
