This study was approved by the ethics committee of the Chamber of Physicians Hamburg, Germany. Pediatric and neonatal patients treated at the University Medical Center Hamburg–Eppendorf (UKE) in the pediatric and neonatal ICUs were eligible. All of the TTE measurements were performed by a single operator (MEB). Three consecutive heart beats for VTI measurements or a single beat for the M-mode measurement were simultaneously recorded with the corresponding identical EV beats. For these M-mode measurements, a single beat was simultaneously measured in triplicate by TTE and EV. In the other method, LVSV was based on M-mode measurement in the long parasternal axis, using the internal algorithm of the echocardiography machine based on the Teichholz equation. In one method, LVSV was calculated based on measurement of the flow velocity time integral (VTI) measured over the aortic valve (measured from an apical four-chamber view with angle correction, if necessary) multiplied by the area of the aortic valve:Īortic valve area = 0.5 × diameter 2 × 3.14 LVSV by TTE was calculated using two different methods. Transthoracic echocardiography measurementsįor echocardiography, either the GE Medical Systems Vivid 7 (CE 0470 GE Healthcare, Munich, Germany) or the GE Healthcare Technologies Logiq P5 (CE 0459 GE Healthcare) ultrasound machine was used. The signal that was generated by the Aesculon® monitor for EV LVSV measurements was accepted if the green signal quality bar indicated a reliable signal. The analyzed heart beats were recorded simultaneously by TTE on the Aesculon® monitor. The electrode position of four RedDot® neonatal ECG radiolucent prewired monitoring electrodes (3M Health Care, Neuss, Germany) was chosen as recommended by the manufacturer.

Electrical velocimetry measurementsĪn Aesculon® monitor (CE 0123 Osypka Medical, Berlin, Germany) was used to record EV. Equivalence of EV and TTE was assumed if Bland–Altman analysis had bias <10% and mean percentage error (MPE) <30% regarding LVSV measurement by EV compared with TTE (H 0).

LVSV was simultaneously measured by EV and TTE. This single-center observational study aimed to validate EV compared with TTE in pediatric intensive care patients with normal cardiac biventricular anatomy. This study shows that EV is comparable with aortic flow-based TTE for pediatric patients. Mechanical ventilation, non-invasive continuous positive airway pressure ventilation, body weight, and secondary abdominal closure were factors that significantly affected comparison of the methods. Bias/MPE for EVMM was 8.07%/37.26% where the OTX and NEURO subgroups were within the range of H 0, but the PREM and SEPSIS subgroups were outside the range. In the EVVTI subgroup analysis for OTX, NEURO, and SEPSIS, bias and MPE were within the limits of H 0, whereas the PREM subgroup had a bias/MPE of 39.00%/46.27%. Patients were divided into subgroups: organ transplantation (OTX, n =28), sepsis or organ failure (SEPSIS, n =16), neurological patients (NEURO, n =9), and preterm infants (PREM, n =26) Bias/MPE for EVVTI was 7.81%/26.16%. ResultsĪ total of 72 patients (age: 2 days to 17 years weight: 0.8 to 86 kg) were analyzed. If appropriate, data were logarithmically transformed prior to Bland–Altman analysis. H 0: bias was less than 10% and the mean percentage error (MPE) was less than 30% in Bland–Altman analysis between EV and TTE. Simultaneous, coupled, left ventricular stroke volume measurements were performed by EV using an Aesculon® monitor and TTE (either via trans-aortic valve flow velocity time integral, or via M-mode ). We compared EV with TTE in pediatric intensive care patients in a prospective single-center observational study. Transthoracic echocardiography (TTE) is non-invasive but discontinuous. Electrical velocimetry (EV) is a type of impedance cardiography, and is a non-invasive and continuously applicable method of cardiac output monitoring.

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