Persson Jessica N, Holstein Jacqueline, Silveira Lori, Irons Aimee, Rajab Taufiek Konrad, Jaggers James, Twite Mark D, Scahill Carly, Kohn Mary, Gold Christine, Davidson Jesse A
Department of Pediatrics, University of Colorado Anschutz, Aurora, CO, United States.
Heart Institute, Children's Hospital Colorado, Aurora, CO, United States.
Front Pediatr. 2021 Aug 23;9:727571. doi: 10.3389/fped.2021.727571. eCollection 2021.
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. 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). 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). 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.
液体超负荷是儿童心脏手术后常见的术后问题，与发病率和死亡率增加相关。目前尚无评估液体状态的金标准。我们试图验证使用床旁超声测量婴儿皮肤水肿并评估使用者内和使用者间的变异性。对接受心脏手术的新生儿（≤30日龄）和婴儿（31日龄至12月龄）以及新生儿对照组进行前瞻性队列研究。在基线时以及术后每日直至术后第3天，在四个身体部位进行皮肤超声检查。手动测量皮下组织深度。使用组内相关系数（ICC）评估使用者内和使用者间的变异性。50名对照组和22名手术组受试者接受了皮肤超声检查。手术组新生儿和对照组新生儿在基线时无差异。新生儿从术后第1天开始皮下组织增加，到术后第3天改善甚微。在婴儿中，这种模式不太明显，到术后第3天几乎消退。使用者内变异性极佳（ICC 0.95）。使用者间变异性非常好（ICC 0.82）。床旁皮肤超声是一种可重复且可靠的方法，可用于测量患有和未患有先天性心脏病的婴儿的皮下组织。皮下组织的急性增加提示皮肤水肿的发展，这与血管外液体超负荷一致。有证据表明所有受试者从术后第1天开始出现皮肤水肿，新生儿到术后第3天无明显改善。床旁超声可能是测量婴儿血管外液体超负荷的一种客观方法。需要进一步研究以确定血管外液体超负荷与临床结局之间的相关性。
