Moving Toward Non-invasive Hemodynamic and Echocardiographic Monitoring in Critical Pediatric Patients in the Emergency Department: Setting Standards

Abstract

This paper aims to identify hemodynamic and echocardiographic standards in pediatric patients in the Emergency Department. The study design is epidemiological, observational, and cross-sectional. The study was carried out in the Emergency Department of the Baca Ortiz Pediatric Hospital, Quito, Ecuador. Inclusion criteria included pediatric patients from 1 month of age up to 15 years old, both sexes, any ethnic group, critical patients with shock, trauma, or respiratory insufficiency, without previous cardiopulmonary comorbidities. We performed echocardiography, assessing volume, fluid responsiveness, left ventricular systolic function, left ventricle diastolic function, right ventricle systolic function, and pericardium. When it was necessary, doctors administered inotropic or vasoactive drugs to stabilize the patient. The volume responder profile was male sex in 61% of the cases, from zero to 5 years in 93.4% of the cases; the mean heart rate was 126, the MAP of 65, and the CVP of 5.5. The ejection fraction and shortening did show significant variability between the two cohorts, trauma and shock. There was not a correlation between peak aortic flow and mean arterial pressure. For the selected model, sensitivity reached 85.7%, specificity of 91.4%, positive predictive value (VPP) of 66.7%, negative predictive value (VPN) of 96.97%, and 90.5%. In the ejection fraction (EF), those who presented systolic dysfunction had significantly lower values than the patients with diastolic dysfunction and the normal ones; the difference between the patients with systolic dysfunction compared with those without dysfunction was − 24.6%, and between the systolic dysfunction and diastolic was − 27.8%. This is the first report on standard hemodynamic values in echocardiography for critically ill pediatric patients. It needs more research to understand these parameters better, focusing on other etiologies, ethnic groups, and more complex variables. This paper’s general message is to show how non-invasive measures can be used sooner in ED rather than just in critical care. The quality of non-invasive monitoring improves care and patient outcomes, length of stay, and mortality, among other essential factors.

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Acknowledgements

The authors thank Catalina Vásquez Hahn, Santiago Pinto Zaldumbide, Carlos Valencia Calderón, authorities of the Baca Ortiz Pediatric Hospital, Rosa Quiguantar Reascos, and Israel Castro González.

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Authors

Contributions

The contributions are equal for all authors. All authors carried out the protocol design, data collection, statistical analysis, assessment, interpretation of the data, critical analysis, discussion, writing, and final manuscript approval. The corresponding author represents a group of authors.

Corresponding author

Correspondence to Fabricio González-Andrade.

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Ethics Approval and Consent to Participate

Subcommittee on Ethics and Research in Human Beings (SEISH) of the Central University of Ecuador approved this research. The legal custodian or the children’s parents gave Informed Consent. Additionally, all parents sign a consent to the admission to the Emergency Department.

Consent for Publication

Parents give their consent for publication, also Hospital Baca Ortiz.

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The authors declare no competing interests.

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Fuenmayor-Oramas, F., González-Andrade, F. & la Cueva, X.PD. Moving Toward Non-invasive Hemodynamic and Echocardiographic Monitoring in Critical Pediatric Patients in the Emergency Department: Setting Standards. SN Compr. Clin. Med. (2021). https://doi.org/10.1007/s42399-021-00804-8

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Keywords

  • Echocardiography
  • Hemodynamics
  • Sepsis
  • Trauma
  • Standardization
  • Respiratory insufficiency
  • Emergency room
  • Ecuador