Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 25 , ISSUE 2 ( February, 2021 ) > List of Articles


Electrocardiometry Fluid Responsiveness in Pediatric Septic Shock

Citation Information : Electrocardiometry Fluid Responsiveness in Pediatric Septic Shock. Indian J Crit Care Med 2021; 25 (2):123-125.

DOI: 10.5005/jp-journals-10071-23745

License: CC BY-NC 4.0

Published Online: 17-04-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Hemodynamic monitoring and categorization of patients based on fluid responsiveness is the key to decisions prompting the use of fluids and vasoactive agents in septic shock. Distinguishing patients who are going to benefit from fluids from those who will not is of paramount importance as large amounts of fluids used conventionally based on surviving sepsis guidelines may be detrimental. Noninvasive monitoring techniques for the assessment of various cardiovascular parameters are increasingly accepted as the current medical practice. Electrical cardiometry (EC) is one such method for the determination of stroke volume, cardiac output (CO), and other hemodynamic parameters and is based on changes in electrical conductivity within the thorax. It has been validated against gold standard methods such as thermodilution [Malik V, Subramanian A, Chauhan S, et al. World J 2014;4(7):101–108] and is being used more often as a point-of-care noninvasive technique for hemodynamic monitoring. EC is Food and Drug Administration approved and validated for use in neonates, children, and adults. A meta-analysis in 2016, including 20 studies and 624 patients comparing the accuracy of CO measurement by using EC with other noninvasive technologies, demonstrated that EC was the device that offered the most correct measurements. The article in the current issue of IJCCM by Rao et al. (2020) has extended the use of EC to categorize pediatric patients with septic shock into vasodilated and vasoconstricted states based on systemic vascular resistance and correlate the categorization clinically. The authors also studied the changes in hemodynamic parameters after an isotonic fluid bolus of 20 mL/kg was administered. This is a pilot prospective observational study of 30 patients, which has given an insight into physiological rearrangements following fluid administration in patients with septic shock.

  1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Massimo A, Ricard F, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017;45(3):486–552. DOI: 10.1007/s00134-017-4683-6.
  2. Osypka M. An introduction to electrical cardiometry™. Berlin, Germany; 2009, pp. 1–10. Available from: (accessed 30 December 2020).
  3. Malik V, Subramanian A, Chauhan S, Hote M. Correlation of electric cardiometry and continuous thermodilution cardiac output monitoring systems. World J Cardiovasc Surg 2014;4(7):101–108. DOI: 10.4236/wjcs.2014.47016.
  4. Narula J, Chauhan S, Ramakrishnan S, Gupta SK. Electrical cardiometry: a reliable solution to cardiac output estimation in children with structural heart disease. J Cardiothorac Vasc Anesth 2017;31(3):912–917. DOI: 10.1053/j.jvca.2016.12.009.
  5. Taylor K, Rotta GL, McCrindle BW, Manlhiot C, Redington A, Holtby H. A comparison of cardiac output by thoracic impedance and direct fick in children with congenital heart disease undergoing diagnostic cardiac catheterization. J Cardiothorac Vasc Anesth 2011;25(5):776–779. DOI: 10.1053/j.jvca.2011.05.002.
  6. Fathi EM, Narchi H, Chedid F. Non-invasive hemodynamic monitoring of septic shock in children. World J Methodol 2018;8(1):1–8. DOI: 10.5662/wjm.v8.i1.1.
  7. Wong HR, Dalton HJ. The PICU perspective on monitoring hemodynamics and oxygen transport. Pediatr Crit Care Med 2011; 12(4 Suppl.):S66–S68. DOI: 10.1097/PCC.0b013e3182211c60.
  8. Cariou A, Pinsky MR, Monchi M, Laurent I, Vinsonneau C, Chiche JD, et al. Is myocardial adrenergic responsiveness depressed in human septic shock? Intensive Care Med 2008;34(5):917–922. DOI: 10.1007/s00134-008-1022-y.
  9. Barbier C, Loubières Y, Schmit C, Hayon J, Ricôme JL, Jardin F, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 2004;30(9):1740–1746. DOI: 10.1007/s00134-004-2259-8.
  10. Lemson J, Nusmeier A, van der Hoeven JG. Advanced hemodynamic monitoring in critically ill children. Pediatrics 2011;128(3):560–571. DOI: 10.1542/peds.2010-2920.
  11. Beltramo F, Menteer J, Razavi A, Khemani RG, Szmuszkovicz J, Newth CJ, et al. Validation of an ultrasound cardiac output monitor as a bedside tool for pediatric patients. Pediatr Cardiol 2016;37(1):177–183. DOI: 10.1007/s00246-015-1261-y.
  12. Suehiro K, Joosten A, Murphy LS, Desebbe O, Alexander B, Kim SH, et al. Accuracy and precision of minimally-invasive cardiac output monitoring in children: a systematic review and meta-analysis. J Clin Monit Comput 2016;30(5):603–620. DOI: 10.1007/s10877-015-9757-9.
  13. Voet M, Nusmeier A, Lerou J, Luijten J, Cornelissen M, Lemson J. Cardiac output-guided hemodynamic therapy for adult living donor kidney transplantation in children under 20 kg: a pilot study. Paediatr Anaesth 2019 Sep;29(9):950–958. DOI: 10.1111/pan.13705.
  14. Rao SS, Reddy M, Lalitha AV, Ghosh S. Electrocardiometry for hemodynamic categorisation and assessment of fluid responsiveness in pediatric septic shock: a pilot observational study. Indian J Crit Care Med 2021;25(2):185–192.
  15. Ranjit S, Aram G, Kissoon N, Ali MK, Natraj R, Shresti S, et al. Multimodal monitoring for hemodynamic categorization and management of pediatric septic shock: a pilot observational study. Pediatr Crit Care Med 2014 Jan;15(1):e17–e26. DOI: 10.1097/PCC.0b013e3182a5589c.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.