Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department
Open accessAbstract
Introduction: The assessment of fluid responsiveness is important in the management of shock but conventional methods of assessing fluid responsiveness are often inaccurate. Our study aims to evaluate changes in objective hemodynamic parameters as measured using electrical cardiometry (ICON ® monitor) following the fluid bolus in children presenting with shock and to evaluate whether any specific hemodynamic parameter can best predict fluid responsiveness among children with shock. Materials and Methods: We conducted a prospective observational study in children presenting with shock to our emergency department between June 2020 and March 2021. We collected the parameters such as heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and hemodynamic data such as cardiac output CO), cardiac index (CI), index of contractility (ICON), stroke volume (SV), stroke index (SI), corrected flow time (FTC), systolic time ratio (STR), variation of index of contractility (VIC), stroke volume variation (SVV), systemic vascular resistance (SVR), and thoracic fluid content (TFC) using the ICON monitor before and after fluid bolus (FB). We assessed percent change (Δ) and used paired-sample Student’s t -test to compare pre- and post-hemodynamic data and Mann–Whitney U -test to compare fluid responders and non-responders. P -Values < 0.05 were considered statistically significant. Results: We recorded 42 fluid interventions in 40 patients during our study period. The median IQR age was 10.56 (4.8, 14.8) years with male/female ratio (1.2:1). There was a significant decrease in ΔRR [−1.61 (−14.8, 0); p = 0.012], ΔDBP [−5.5 (−14.4, 8); p = 0.027], ΔMAP [−2.2 (−11, 2); p = 0.018], ΔSVR [−5.8 (−20, 5.2); p = 0.025], and ΔSTR [−8.39 (−21, 3); p = 0.001] and significant increase in ΔTFC [6.2 (3.5, 11.4); p = 0.01] following FB. We defined fluid responders by an increase in SV by ≥10% after a single FB of 20 ml/kg crystalloid. Receiver operating curve analysis revealed that among all the parameters, 15% change in ICON had an excellent AUC (0.85) for the fluid responsiveness. Conclusion: Our study showed significant changes in objective hemodynamic parameters, such as SVR, STR, and TFC following FB in children presenting with shock. A 15% change in ICON had an excellent predictive performance for the fluid responsiveness among our cohort of pediatric shock.
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Thoracic fluid content measured by electrical cardiometry evaluates fluid responsiveness in children with shock.
“evaluating fluid responsiveness in children with shock [77]”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [77]
The Methods report measuring thoracic fluid content (TFC) with an electrical cardiometry device in children with shock. But the Results (Effects of Fluid Therapy and Fluid Responsiveness; page not available) found no significant difference in TFC change between fluid responders and non-responders. The paper identifies other measures—not TFC—as predictors of fluid responsiveness. (LLM, conf=0.88)
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“…variety of clinical scenarios, such as predicting outcomes in critically ill children [76], evaluating fluid responsiveness in children with shock [77], detecting pulmonary congestion [78], monitoring fluid overload during hemodialysis [79], and distinguishing between hemodynamically significant…”
- Authors
- Awadhare, P., Patel, R., McCallin, T., Mainali, K., Jackson, K., Starke, H., & Bhalala, U.
- Affiliations
- Children's Hospital of San Antonio (US)
- University of the Incarnate Word (US)
- University Hospitals of Cleveland (US)
- Driscoll Children's Hospital (US)
- Corresponding author
- Bhalala, Utpal
- Venue
- Frontiers in Pediatrics
- Publisher
- Frontiers Media SA
- Published
- 2022-04-07
- Volume
- 10
- Pages
- 857106-857106
- ISSN
- 2296-2360 (ISSN-L)
- PMC
- PMC9021702
- OpenAlex
- W4225647000
- Cited by
- 9
- References
- 44
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 2
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Pediatrics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Keywords
- fluid responsiveness, pediatric shock, cardiac output monitoring, electrical cardiometry, fluid bolus, hemodynamic parameters, stroke volume variation, systemic vascular resistance, thoracic fluid content, children, emergency department, non-invasive monitoring, fluid resuscitation, urine output, urine specific gravity, urine osmolality
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