Consistency between Impedance Technique and Echocardiogram Hemodynamic Measurements in Neonates

Abstract

Objective The aim of this study was to validate impedance technique (IT) by investigating the agreement in cardiac output measurements performed by IT and echocardiography (ECHO).

Study design This is a prospective observational study, including a total of 30 neonates who underwent hemodynamic measurements by IT and ECHO. To determine the agreement between both methods, we performed IT to measure stroke volume (SV-IT) and cardiac output (CO-IT) immediately before or after ECHO to measure SV (SV-ECHO) and CO (CO-ECHO). The precision and accuracy of the IT relative to ECHO were assessed.

Results SV-ECHO and SV-IT were (4.45 ± 0.78) and (4.54 ± 0.81) mL, respectively. The bias and limits of agreement of SV-IT were 0.09 mL and ( –1.92 to 1.73) mL, respectively. The true precision of SV-IT was 27.3%. Furthermore, CO-ECHO and CO-IT were (0.62 ± 0.12) and (0.61 ± 0.12) L/min, respectively. The bias and LoA of CO-IT were 0.01L/min and (–0.33 to 0.31) L/min, respectively. The true precision of CO-IT was 28.3%.

Conclusion Agreement between the IT and ECHO in the cardiac output measurement appeared acceptable. However, the accuracy and precision of the IT approach should be further investigated using a larger sample.

Keywords

impedance technique - echocardiogram - cardiac output - Bland–Altman analysis

Publication History

Received: 22 October 2019

Accepted: 19 March 2020

Article published online:
25 April 2020

• References

• 1 Davis AL, Carcillo JA, Aneja RK. et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med 2017; 45 (06) 1061-1093
• 2 Nguyen LS, Squara P. Non-invasive monitoring of cardiac output in critical care medicine. Front Med (Lausanne) 2017; 4 (06) 200-208
• 3 Cotter G, Moshkovitz Y, Kaluski E. et al. Accurate, noninvasive continuous monitoring of cardiac output by whole-body electrical bioimpedance. Chest 2004; 125 (04) 1431-1440
• 4 Feng Y, Zou Y, Zheng Y, Levin NW, Wang L. The value of non-invasive measurement of cardiac output and total peripheral resistance to categorize significant changes of intradialytic blood pressure: a prospective study. BMC Nephrol 2018; 19 (01) 310-316
• 5 Noori S, Drabu B, Soleymani S, Seri I. Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography. Arch Dis Child Fetal Neonatal Ed 2012; 97 (05) F340-F343
• 6 Giavarina D. Understanding Bland–Altman analysis. Biochem Med (Zagreb) 2015; 25 (02) 141-151
• 7 Cecconi M, Rhodes A, Poloniecki J, Della Rocca G, Grounds RM. Bench-to-bedside review: the importance of the precision of the reference technique in method comparison studies--with specific reference to the measurement of cardiac output. Crit Care 2009; 13 (01) 201-206
• 8 Chew MS, Poelaert J. Accuracy and repeatability of pediatric cardiac output measurement using Doppler: 20-year review of the literature. Intensive Care Med 2003; 29 (11) 1889-1894
• 9 Singh Y. Echocardiographic evaluation of hemodynamics in neonates and children. Front Pediatr 2017; 5: 201
• 10 Lee EP, Hsia SH, Lin JJ. et al. Hemodynamic analysis of pediatric septic shock and cardiogenic shock using transpulmonary thermodilution. BioMed Res Int 2017; 2017: 3613475-3613481
• 11 An YJ, Kim BH, Yun GH, Kim SW, Hong SB, Yook JG. Flexible non-constrained RF wrist pulse detection sensor based on array resonators. IEEE Trans Biomed Circuits Syst 2016; 10 (02) 300-308
• 12 Suehiro K, Joosten A, Murphy LS. et al. Accuracy and precision of minimally-invasive cardiac output monitoring in children: a systematic review and meta-analysis. J Clin Monit Comput 2016; 30 (05) 603-620
• 13 Hsu KH, Wu TW, Wu IH. et al. Electrical cardiometry to monitor cardiac output in preterm infants with patent ductus arteriosus: a comparison with echocardiography. Neonatology 2017; 112 (03) 231-237
• 14 Weisz DE, Jain A, McNamara PJ, EL-Khuffash A. Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography. Neonatology 2012; 102 (01) 61-67
• 15 Matsuda Y, Kawate H, Shimada S. et al. Perioperative sequential monitoring of hemodynamic parameters in patients with pheochromocytoma using the non-invasive cardiac system (NICaS). Endocr J 2014; 61 (06) 571-575
• 16 Schena E, Cecchini S, Saccomandi P, Leuzzi M, Silvestri S. An algorithm to improve the estimation accuracy of a non-invasive method for cardiac output measurement based on prolonged expiration. Conf Proc IEEE Eng Med Biol Soc 2013; 2013: 1823-1826