Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study.
PURPOSE: To determine the feasibility of using the Ultrasound Cardiac Output Monitor (USCOM) as an adjunct during hemodynamic assessments by a pediatric medical emergency team (PMET). METHODS: Pediatric in-patients at McMaster Children's Hospital aged under 18 years requiring urgent PMET consul...
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doaj-572be867f6e54e029fa9830c30e17b772020-11-25T02:19:46ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0186e6695110.1371/journal.pone.0066951Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study.David J ZorkoKaren ChoongJonathan GillelandBarbara AgarShawn BakerCindy BrennanEleanor PullenayegumPURPOSE: To determine the feasibility of using the Ultrasound Cardiac Output Monitor (USCOM) as an adjunct during hemodynamic assessments by a pediatric medical emergency team (PMET). METHODS: Pediatric in-patients at McMaster Children's Hospital aged under 18 years requiring urgent PMET consultation, were eligible. Patients with known cardiac outflow valve defects, Pediatric Critical Care Unit in-patients, and those in cardiorespiratory arrest, were excluded. The primary outcome was feasibility, and the ease of USCOM transport and application as assessed by a self-administered user questionnaire. Secondary outcomes included the quality of USCOM measurements, and agreement in clinical versus USCOM-derived assessments. RESULTS: Forty-one patients from 85 eligible PMET consultations were enrolled between March and August 2011. A total of 55 USCOM assessments were performed on 36 of 41 (87.8%) participants. USCOM could not be completed in 5 (12.2%) participants due to patient agitation (n = 4) and emergent care (n = 1). USCOM was reported as easy to transport and apply by 97.4% and 94.7% of respondents respectively, not obstructive to patient care by 94.7%, and yielded timely measurements by 84.2% respondents. USCOM tracings were of good quality in 41 (75.9%) assessments. Agreement between clinical and USCOM-derived hemodynamic assessments by two independent raters was poor (Rater 1: κ = 0.094; Rater 2: κ = 0.146). CONCLUSION: USCOM can be applied by a PMET during urgent hemodynamic assessments in children. While USCOM has been validated in stable children, its role in guiding hemodynamic resuscitation and informing therapeutic goals in a hemodynamically unstable pediatric population requires further investigation.http://europepmc.org/articles/PMC3692535?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
David J Zorko Karen Choong Jonathan Gilleland Barbara Agar Shawn Baker Cindy Brennan Eleanor Pullenayegum |
spellingShingle |
David J Zorko Karen Choong Jonathan Gilleland Barbara Agar Shawn Baker Cindy Brennan Eleanor Pullenayegum Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study. PLoS ONE |
author_facet |
David J Zorko Karen Choong Jonathan Gilleland Barbara Agar Shawn Baker Cindy Brennan Eleanor Pullenayegum |
author_sort |
David J Zorko |
title |
Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study. |
title_short |
Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study. |
title_full |
Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study. |
title_fullStr |
Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study. |
title_full_unstemmed |
Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study. |
title_sort |
urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2013-01-01 |
description |
PURPOSE: To determine the feasibility of using the Ultrasound Cardiac Output Monitor (USCOM) as an adjunct during hemodynamic assessments by a pediatric medical emergency team (PMET). METHODS: Pediatric in-patients at McMaster Children's Hospital aged under 18 years requiring urgent PMET consultation, were eligible. Patients with known cardiac outflow valve defects, Pediatric Critical Care Unit in-patients, and those in cardiorespiratory arrest, were excluded. The primary outcome was feasibility, and the ease of USCOM transport and application as assessed by a self-administered user questionnaire. Secondary outcomes included the quality of USCOM measurements, and agreement in clinical versus USCOM-derived assessments. RESULTS: Forty-one patients from 85 eligible PMET consultations were enrolled between March and August 2011. A total of 55 USCOM assessments were performed on 36 of 41 (87.8%) participants. USCOM could not be completed in 5 (12.2%) participants due to patient agitation (n = 4) and emergent care (n = 1). USCOM was reported as easy to transport and apply by 97.4% and 94.7% of respondents respectively, not obstructive to patient care by 94.7%, and yielded timely measurements by 84.2% respondents. USCOM tracings were of good quality in 41 (75.9%) assessments. Agreement between clinical and USCOM-derived hemodynamic assessments by two independent raters was poor (Rater 1: κ = 0.094; Rater 2: κ = 0.146). CONCLUSION: USCOM can be applied by a PMET during urgent hemodynamic assessments in children. While USCOM has been validated in stable children, its role in guiding hemodynamic resuscitation and informing therapeutic goals in a hemodynamically unstable pediatric population requires further investigation. |
url |
http://europepmc.org/articles/PMC3692535?pdf=render |
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