From the Department of Pediatrics, Faculty Hospital, Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic.
Pediatr Emerg Care. 2023 Sep 1;39(9):680-684. doi: 10.1097/PEC.0000000000003018. Epub 2023 Jul 22.
Stroke volume (SV) and cardiac output monitoring is a cornerstone of hemodynamic assessment. Noninvasive technologies are increasingly used in children. This study compared SV measurements obtained by transcutaneous Doppler ultrasound techniques (ultrasonic cardiac output monitor [USCOM]), transthoracic echocardiography jugular (TTE-J), and parasternal (TTE-P) views performed by pediatric intensivists (OP-As) with limited training in cardiac sonography (20 previous examinations) and pediatric cardiologists (OP-Bs) with limited training in USCOM (30 previous examinations) in spontaneously ventilating children.
A single-center study was conducted in 37 children. Each operator obtained 3 sets of USCOM SV measurements within a period of 3 to 5 minutes, followed with TTE measurements from both apical and jugular views. The investigators were blinded to each other's results to prevent visual and auditory bias.
Both USCOM and TTE methods were applicable in 89% of patients. The intraobserver variability of USCOM, TTE-J, and TTE-P were less than 10% in both investigators. The SV measurements by OP-As using USCOM, TTE-J, and TTE-P were 46.15 (25.48) mL, 39.45 (20.65) mL, and 33.42 (16.69) mL, respectively. The SV measurements by OP-Bs using USCOM, TTE-J, and TTE-P were 43.99 (25.24) mL, 38.91 (19.98) mL, and 37.58 (19.81) mL, respectively.The percentage error in SV with USCOM relative to TTE-J was 36% in OP-As and 37% in OP-Bs. The percentage error in SV with TTE-P was 33% relative to TTE-J in OP-As and 21% in OP-Bs.
Our findings show that the methods are not interchangeable because SV values by USCOM are higher in comparison with the SV values obtained by TTE. Both methods have low level of intraobserver variability. The SV measurements obtained by TTE-P were significantly lower compared with the TTE-J for the operator with limited training in echocardiography. The TTE-P requires longer practice compared with the TTE-J; therefore, we recommend to prefer TTE-J to TTE-P for inexperienced operators.
心输出量和每搏量监测是血流动力学评估的基石。非侵入性技术在儿童中越来越多地被使用。本研究比较了经皮多普勒超声技术（超声心输出量监测仪[USCOM]）、经胸超声心动图（TTE）心尖和颈静脉（TTE-J）以及胸骨旁（TTE-P）视图在接受过有限的心脏超声检查培训的儿科重症监护医生（OP-As，共进行了 20 次检查）和接受过有限的 USCOM 培训的儿科心脏病专家（OP-Bs，共进行了 30 次检查）中对自主呼吸儿童的心输出量测量的应用。
在一个中心进行了一项单中心研究，共纳入 37 名儿童。每位操作者在 3 至 5 分钟内获得 3 组 USCOM 每搏量测量值，随后进行 TTE 心尖和颈静脉视图测量。研究人员彼此之间的结果是盲法的，以防止视觉和听觉偏倚。
两种 USCOM 和 TTE 方法均可用于 89%的患者。在两名研究人员中，USCOM、TTE-J 和 TTE-P 的观察者内变异性均小于 10%。OP-As 使用 USCOM、TTE-J 和 TTE-P 测量的每搏量分别为 46.15（25.48）mL、39.45（20.65）mL 和 33.42（16.69）mL。OP-Bs 使用 USCOM、TTE-J 和 TTE-P 测量的每搏量分别为 43.99（25.24）mL、38.91（19.98）mL 和 37.58（19.81）mL。与 TTE-J 相比，USCOM 测量的每搏量在 OP-As 中的相对误差为 36%，在 OP-Bs 中为 37%。与 TTE-J 相比，TTE-P 在 OP-As 中的相对误差为 33%，在 OP-Bs 中为 21%。
我们的研究结果表明，这些方法不能互换，因为与 TTE 获得的每搏量值相比，USCOM 获得的每搏量值较高。两种方法的观察者内变异性均较低。与 TTE-J 相比，接受过有限的超声心动图培训的操作者 TTE-P 测量的每搏量明显较低。与 TTE-J 相比，TTE-P 需要更长的实践时间，因此，我们建议经验不足的操作者优先选择 TTE-J 而不是 TTE-P。
