Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease
Purpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.727571/full |
| _version_ | 1823932839468466176 |
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| author | Jessica N. Persson Jessica N. Persson Jacqueline Holstein Lori Silveira Aimee Irons Taufiek Konrad Rajab Taufiek Konrad Rajab James Jaggers James Jaggers Mark D. Twite Carly Scahill Carly Scahill Mary Kohn Christine Gold Jesse A. Davidson Jesse A. Davidson |
| author_facet | Jessica N. Persson Jessica N. Persson Jacqueline Holstein Lori Silveira Aimee Irons Taufiek Konrad Rajab Taufiek Konrad Rajab James Jaggers James Jaggers Mark D. Twite Carly Scahill Carly Scahill Mary Kohn Christine Gold Jesse A. Davidson Jesse A. Davidson |
| author_sort | Jessica N. Persson |
| collection | DOAJ |
| description | Purpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in infants and assess the intra- and inter-user variability.Methods: Prospective cohort study of neonates (≤30 d/o) and infants (31 d/o to 12 m/o) undergoing cardiac surgery and neonatal controls. Skin ultrasound was performed on four body sites at baseline and daily post-operatively through post-operative day (POD) 3. Subcutaneous tissue depth was manually measured. Intra- and inter-user variability was assessed using intraclass correlation coefficient (ICC).Results: Fifty control and 22 surgical subjects underwent skin ultrasound. There was no difference between baseline surgical and control neonates. Subcutaneous tissue increased in neonates starting POD 1 with minimal improvement by POD 3. In infants, this pattern was less pronounced with near resolution by POD 3. Intra-user variability was excellent (ICC 0.95). Inter-user variability was very good (ICC 0.82).Conclusion: Point-of-care skin ultrasound is a reproducible and reliable method to measure subcutaneous tissue in infants with and without congenital heart disease. Acute increases in subcutaneous tissue suggests development of skin edema, consistent with extravascular fluid overload. There is evidence of skin edema starting POD 1 in all subjects with no substantial improvement by POD 3 in neonates. Point-of-care ultrasound could be an objective way to measure extravascular fluid overload in infants. Further research is needed to determine how extravascular fluid overload correlates to clinical outcomes. |
| first_indexed | 2024-12-16T21:57:42Z |
| format | Article |
| id | doaj.art-2c8f4a8884bd4e64a0a8e2849c44e892 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-16T21:57:42Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-2c8f4a8884bd4e64a0a8e2849c44e8922022-12-21T22:14:44ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-08-01910.3389/fped.2021.727571727571Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart DiseaseJessica N. Persson0Jessica N. Persson1Jacqueline Holstein2Lori Silveira3Aimee Irons4Taufiek Konrad Rajab5Taufiek Konrad Rajab6James Jaggers7James Jaggers8Mark D. Twite9Carly Scahill10Carly Scahill11Mary Kohn12Christine Gold13Jesse A. Davidson14Jesse A. Davidson15Department of Pediatrics, University of Colorado Anschutz, Aurora, CO, United StatesHeart Institute, Children's Hospital Colorado, Aurora, CO, United StatesResearch Institute, Children's Hospital Colorado, Aurora, CO, United StatesDepartment of Pediatrics, University of Colorado Anschutz, Aurora, CO, United StatesHeart Institute, Children's Hospital Colorado, Aurora, CO, United StatesHeart Institute, Children's Hospital Colorado, Aurora, CO, United StatesSection of Congenital Heart Surgery, University of Colorado Anschutz, Aurora, CO, United StatesHeart Institute, Children's Hospital Colorado, Aurora, CO, United StatesSection of Congenital Heart Surgery, University of Colorado Anschutz, Aurora, CO, United StatesDepartment of Anesthesiology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, CO, United StatesDepartment of Pediatrics, University of Colorado Anschutz, Aurora, CO, United StatesHeart Institute, Children's Hospital Colorado, Aurora, CO, United StatesDepartment of Pediatrics, University of Colorado Anschutz, Aurora, CO, United StatesDepartment of Pediatrics, University of Colorado Anschutz, Aurora, CO, United StatesDepartment of Pediatrics, University of Colorado Anschutz, Aurora, CO, United StatesHeart Institute, Children's Hospital Colorado, Aurora, CO, United StatesPurpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in infants and assess the intra- and inter-user variability.Methods: Prospective cohort study of neonates (≤30 d/o) and infants (31 d/o to 12 m/o) undergoing cardiac surgery and neonatal controls. Skin ultrasound was performed on four body sites at baseline and daily post-operatively through post-operative day (POD) 3. Subcutaneous tissue depth was manually measured. Intra- and inter-user variability was assessed using intraclass correlation coefficient (ICC).Results: Fifty control and 22 surgical subjects underwent skin ultrasound. There was no difference between baseline surgical and control neonates. Subcutaneous tissue increased in neonates starting POD 1 with minimal improvement by POD 3. In infants, this pattern was less pronounced with near resolution by POD 3. Intra-user variability was excellent (ICC 0.95). Inter-user variability was very good (ICC 0.82).Conclusion: Point-of-care skin ultrasound is a reproducible and reliable method to measure subcutaneous tissue in infants with and without congenital heart disease. Acute increases in subcutaneous tissue suggests development of skin edema, consistent with extravascular fluid overload. There is evidence of skin edema starting POD 1 in all subjects with no substantial improvement by POD 3 in neonates. Point-of-care ultrasound could be an objective way to measure extravascular fluid overload in infants. Further research is needed to determine how extravascular fluid overload correlates to clinical outcomes.https://www.frontiersin.org/articles/10.3389/fped.2021.727571/fullpoint-of-care ultrasoundcongenital heart diseasefluid overloadcardiac surgeryedema |
| spellingShingle | Jessica N. Persson Jessica N. Persson Jacqueline Holstein Lori Silveira Aimee Irons Taufiek Konrad Rajab Taufiek Konrad Rajab James Jaggers James Jaggers Mark D. Twite Carly Scahill Carly Scahill Mary Kohn Christine Gold Jesse A. Davidson Jesse A. Davidson Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease Frontiers in Pediatrics point-of-care ultrasound congenital heart disease fluid overload cardiac surgery edema |
| title | Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease |
| title_full | Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease |
| title_fullStr | Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease |
| title_full_unstemmed | Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease |
| title_short | Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease |
| title_sort | validation of point of care ultrasound to measure perioperative edema in infants with congenital heart disease |
| topic | point-of-care ultrasound congenital heart disease fluid overload cardiac surgery edema |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.727571/full |
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