SESSION TITLE: Pediatric Critical Care Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Central venous pressure (CVP) monitoring can be useful in clinical decision making in the pediatric intensive care unit (PICU), but it is invasive and not always available. We examined the relationship between CVP and ultrasonographic (US) measurements of maximal and minimal inferior vena cava (IVC) diameters during the respiratory cycle (IVCDmax; IVCDmin), IVC collapsibility index (IVCCI), and ratios of IVCDmax and IVCDmin to aortic diameter (AoD) in mechanically ventilated PICU patients.
METHODS: Critically ill medical and surgical PICU patients receiving mechanical ventilation and CVP monitoring were prospectively recruited. M-mode measurements of IVCDmax, IVCDmin, and AoD were obtained in the transverse subxiphoid view, and the simultaneous invasive CVP measurements were recorded in mmHg. IVCCI was calculated as (IVCDmax−IVCDmin)/IVCDmax. Pearson correlation coefficient (r) was used to evaluate the relationship between the parameters of interest and CVP.
RESULTS: Seventeen patients (1 wk-17 yrs; CVP 4-16) have been enrolled to date, with target enrollment of 50. In all patients, regardless of age and CVP, IVCCI and IVCmin/AoD correlated with CVP (r=−0.62 and 0.56; p<0.05 for both). Only the correlation between IVCCI and CVP remained significant in the subgroup of patients <13 years old (r=−0.60; p<0.05). Furthermore, in this subgroup, this correlation was stronger in patients with CVP ≤10 (r=−0.93; p<0.05). All these findings are unique to this study.
CONCLUSIONS: In our patients, CVP correlated with IVCCI and IVCmin/AoD in all children. Children <13 years showed a moderate to strong correlation between CVP and IVCCI, stronger in those with CVP≤10, which suggests that IVCCI may be more useful in pre-teens with lower CVP. To our knowledge, this is the first report of a significant correlation between CVP and routine US parameters of the IVC in a diverse population of critically ill mechanically ventilated children.
CLINICAL IMPLICATIONS: Contrary to previously published pediatric data, US estimation of CVP based on simple IVC indices may be possible in critically ill mechanically ventilated children across a clinically relevant range of age and CVP.
DISCLOSURE: The following authors have nothing to disclose: Elisabeth Hooper, Denise Angst, Stephen Neuberger, Michael Tsifansky
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