Repeated bedside echocardiography in children with respiratory failureReport as inadecuate

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Cardiovascular Ultrasound

, 9:14

First Online: 26 April 2011Received: 28 March 2011Accepted: 26 April 2011


BackgroundThe aim of this study was to verify the benefits and limitations of repeated bedside echocardiographic examinations in children during mechanical ventilation. For the purposes of this study, we selected the data of over a time period from 2006 to 2010.

MethodsA total of 235 children, average age 3.21 SD 1.32 years were included into the study and divided into etiopathogenic groups. High-risk groups comprised: Acute lung injury and acute respiratory distress syndrome ALI-ARDS, return of spontaneous circulation after cardiopulmonary resuscitation ROSC, bronchopulmonary dysplasia BPD, cardiomyopathy CMP and cardiopulmonary disease CPD. Transthoracic echocardiography was carried out during mechanical ventilation. The following data were collated for statistical evaluation: right and left ventricle myocardial performance indices RV MPI; LV MPI, left ventricle shortening fraction SF, cardiac output CO, and the mitral valve ratio of peak velocity of early wave E to the peak velocity of active wave A as E-A ratio. The data was processed after a period of recovery, i.e. one hour after the introduction of invasive lines time-1 and after 72 hours of comprehensive treatment time-2. The overall development of parameters over time was compared within groups and between groups using the distribution-free Wilcoxons and two-way ANOVA tests.

ResultsA total of 870 echocardiographic examinations were performed. At time-1 higher average values of RV MPI 0.34, SD 0.01 vs. 0.21, SD 0.01; p < 0.001 were found in all groups compared with reference values. Left ventricular load in the high-risk groups was expressed by a higher LV MPI 0.39, SD 0.13 vs. 0.29, SD 0.02; p < 0.01 and lower E-A ratio 0.95, SD 0.36 vs. 1.36, SD 0.64; p < 0.001, SF 0.37, SD 0.11 vs. 0.47, SD 0.02; p < 0.01 and CO 1.95, SD 0.37 vs. 2.94, SD 1.03; p < 0.01. At time-2 RV MPI were lower 0.25, SD 0.02 vs. 0.34, SD 0.01; p < 0.001, but remained higher compared with reference values 0.25, SD 0.02 vs. 0.21, SD 0.01; p < 0.05. Other parameters in high-risk groups were improved, but remained insignificantly different compared with reference values.

ConclusionEchocardiography complements standard monitoring of valuable information regarding cardiac load in real time. Chest excursion during mechanical ventilation does not reduce the quality of the acquired data.

List of abbreviationsALI-ARDSacute lung injury and acute respiratory distress syndrome

Asthmaasthmatic condition

AVCOtime interval from cessation to the onset of mitral or tricuspid inflow

BOAbronchiolitis acuta

BPDbronchopulmonary dysplasia

COcardiac output according to the Teichholtz formula


CPDcardiopulmonary disease

E-A ratiomitral valve ratio of peak velocity of the wave E to wave A.

LV MPIleft ventricle myocardial performance index

PRISMPredicted Risk of Mortality Score pediatric version

PICUPaediatric Intensive Care Unit

PPGpeak pressure grading

RAPM ratioRatio of Actual to Predicted Mortality

ROSCreturn of spontaneous circulation after successful cardiopulmonary resuscitation

RV MPIright ventricle myocardial performance index

Sepsissevere sepsis and septic shock according to the Society of Critical Care Medicine

SFleft ventricle shortening fraction

TTEtransthoracic echocardiography.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-7120-9-14 contains supplementary material, which is available to authorized users.

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Author: Jiri Kobr - Jiri Fremuth - Katerina Pizingerova - Lumir Sasek - Petr Jehlicka - Sarka Fikrlova - Zdenek Slavik


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