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Cardiac output assessed by non-invasive monitoring is associated with ECG changes in children with critical asthma

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Abstract

The primary aim of this study was to determine changes in CI and SI, if any, in children hospitalized with status asthmatics during the course of treatment as measured by non-invasive EC monitoring. The secondary aim was to determine if there is an association between Abnormal CI (defined as <5 or >95 % tile adjusted for age) and Abnormal ECG (defined as ST waves changes) Non-invasive cardiac output (CO) recordings were obtained daily from admission (Initial) to discharge (Final). Changes in CI and SI measurements were compared using paired t tests or 1-way ANOVA. The association between Abnormal CI on Initial CO recording and Abnormal ECG was analyzed by Fischer’s exact test. Data are presented as mean ± SEM with mean differences reported with 95 % confidence interval; p < 0.05 was considered significant. Thirty-five children with critical asthma were analyzed. CI decreased from 6.2 ± 0.2 to 4.5 ± 0.1 [−1.6 (−0.04 to −0.37)] L/min/m2 during hospitalization. There was no change in SI. There was a significant association between Abnormal Initial CI and Abnormal ECG (p = 0.02). In 11 children requiring prolonged hospitalization CI significantly decreased from 7.2 ± 0.5 to 4.0 ± 0.2 [−3.2 (−4.0 to −2.3)] L/min/m2 and SI decreased from 51.2 ± 3.8 to 40.3 ± 2.0 [−11.0 (−17.6 to −4.4)] ml/beat/m2 There was a significant decrease in CI in all children treated for critical asthma. In children that required a prolonged course of treatment, there was also a significant decrease in SI. Abnormal CI at Initial CO recording was associated with ST waves changes on ECG during hospitalization. Future studies are required to determine whether non-invasive CO monitoring can predict which patients are at risk for developing abnormal ECG.

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Abbreviations

CI:

Cardiac index

SI:

Stroke index

SVRI:

Systemic vascular resistance index

HR:

Heart rate

MAP:

Mean arterial pressure

ECG:

Electrocardiogram

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Acknowledgments

The authors would like to express their gratitude to Melissa Whalen BS for editorial and administrative assistance.

Conflict of interest

Jackson Wong has a Clinical Trial Agreement with Cardiotronic Inc, La Jolla CA. Cardiotronic Inc provided funding for this investigator’s initiative study. The research proposal, design and conduct of the study, data analysis, and manuscript preparation, were performed solely by the investigators at Boston Children’s Hospital. The co-authors do not report a conflict of interest. No author(s) received an honorarium or grant to write this manuscript.

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Authors and Affiliations

  1. Division of Medicine Critical Care, Department of Medicine, Children’s Hospital Boston and Harvard Medical School, 330 Longwood Avenue 11 South, Boston, MA, 02115, USA

    Jackson Wong, Kate Dorney, Megan Hannon & Garry M. Steil

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  1. Jackson Wong
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  2. Kate Dorney
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  3. Megan Hannon
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  4. Garry M. Steil
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Correspondence to Jackson Wong.

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Wong, J., Dorney, K., Hannon, M. et al. Cardiac output assessed by non-invasive monitoring is associated with ECG changes in children with critical asthma. J Clin Monit Comput 28, 75–82 (2014). https://doi.org/10.1007/s10877-013-9498-6

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  • DOI: https://doi.org/10.1007/s10877-013-9498-6

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