Original ArticlesNoninvasive Cardiac Output Estimation by Inert Gas Rebreathing in Mechanically Ventilated Pediatric Patients
Section snippets
Methods
Patients weighing >9 kg who were scheduled for clinically indicated cardiac catheterization with endotracheal intubation and mechanical ventilation were recruited for the study between September 2014 and March 2015. The weight threshold was chosen based upon theoretical concerns about dead space proportions and gas sampling rate. Patient-related exclusion criteria included left-to-right shunt (based on our previous work demonstrating the unreliability of IGR in this group9) or moment-to-moment
Results
PAS and catheterization measurements were attempted in 29 patients, and 18 patients were included in the final analysis. Of the 11 excluded patients, 7 were for reasons unrelated to PAS measurement (Figure 2; available at www.jpeds.com). Characteristics of the 18 patients whose data were analyzed are presented in Table I. This final sample was 50% female, with an age range of 4-23 years and weight range of 16.6-72.4 kg. Cardiac diagnoses are listed in Table II. Three patients (17%) had
Discussion
This report builds on previous investigations by demonstrating the feasibility and accuracy of Qp measurement using current-generation IGR and PAS technology in mechanically ventilated pediatric patients with and without structural heart disease. This experience demonstrates that IGR is consistently feasible in patients weighing >15 kg with no ETT leak and no recent exposure to the blood-soluble test gas, N2O. IGR estimates of Qp (which, in the absence of shunts, equals cardiac output) agreed
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Supported by the Tommy Kaplan Fund for Cardiovascular Sciences (to A.P.) and the Dunlevie Family Fund (to A.O.). Gas canisters, MiniValve adaptor, and disposables for inert gas rebreathing measurements, as well as technical support funds were also provided by InnoCC (Odense, Denmark). Although InnoCC provided technical assistance when requested by the authors during the initial study design and testing, InnoCC had no role in study design, collection, analysis or interpretation of data, drafting or editing of the manuscript, or the decision to submit the paper for publication. The authors declare no conflicts of interest.
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Current address: Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.