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The Pressure Recording Analytical Method, invasive hemodynamic monitoring, is an uncalibrated pulse contour analysis, installed in the Mostcare® system that allows a continuous estimation of the stroke volume and thus the cardiac output, by the relationship between the area under the curve of the systolic portion of the arterial blood pressure curve and the dynamic impedance of the cardiovascular system.
The objectives of the study are to compare the changes in cardiac output and stroke volume obtained by the Mostcare® device with those of trans-thoracic echocardiography and to determine if the parameters measured by the Mostcare® predict the response to vascular filling in postoperative and traumatized children, for whom vascular filling is indicated.
Children undergoing major surgery or severe trauma with bleeding require regular hemodynamic evaluation, including cardiac output measurement, to maintain adequate organ perfusion. In fact, administration of fluid to improve cardiac output is the mainstay of hemodynamic resuscitation. However, not all patients respond to fluid therapy, and excessive fluid administration is harmful. Therefore, the vascular filling strategy requires a thorough hemodynamic evaluation.
Many predictive tools for fluid responsiveness have been validated in adults, and are based on heart-lung interaction in ventilated patients. Up to now, respiratory variation in aortic blood flow peak velocity, measured by transthoracic or transoesophageal cardiac echocardiography, is the only variable shown to effectively predict fluid responsiveness in children.
However, the use of these methods does not allow continuous monitoring (trans-thoracic echocardiography) or is not easily achievable in current practice (trans-esophageal echocardiography). In addition, these monitoring tools require learning and inter- and intra-individual variability is not negligible, ranging from 1% to 20%.
The Pressure Recording Analytical Method, invasive hemodynamic monitoring, is an uncalibrated pulse contour analysis, installed in the Mostcare® system, that allows a continuous estimation of the stroke volume and thus of the cardiac output, by the relationship between the area under the curve of the systolic portion of the arterial blood pressure curve and the dynamic impedance of the cardiovascular system.
The objectives of the study are to compare the changes in cardiac output and stroke volume obtained by the Mostcare® device with those of trans-thoracic echocardiography and to determine if the parameters measured by the Mostcare® predict the fluid responsiveness in surgical or severely traumatized children for whom administration of fluid is indicated.
Mostcare® device, Transthoracic cardiac ultrasound
Hôpital Necker-Enfants Malades
Not yet recruiting
Assistance Publique - Hôpitaux de Paris
Published on BioPortfolio: 2019-12-10T01:20:57-0500
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