Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 19 , ISSUE 1 ( 2015 ) > List of Articles


Comparison of monitoring performance of bioreactance versus esophageal Doppler in pediatric patients

Clément Dubost, Adrien Bouglé, Calliope Hallynck, Matthieu Le Dorze, Philippe Roulleau, Catherine Baujard, Dan Benhamou

Keywords : Cardiac bioreactance, cardiac index, pediatric patients, perioperative monitoring

Citation Information : Dubost C, Bouglé A, Hallynck C, Dorze ML, Roulleau P, Baujard C, Benhamou D. Comparison of monitoring performance of bioreactance versus esophageal Doppler in pediatric patients. Indian J Crit Care Med 2015; 19 (1):3-8.

DOI: 10.4103/0972-5229.148630

License: CC BY-ND 3.0

Published Online: 01-11-2015

Copyright Statement:  Copyright © 2015; The Author(s).


Background and Aims: Cardiac output (CO) monitoring and goal-directed therapy during major abdominal surgery is currently used to decrease postoperative complications. However, few monitors are currently available for pediatric patients. Nicom ® is a noninvasive CO monitoring technique based on the bioreactance principle (analysis of frequency variations of a delivered oscillating current traversing the thoracic cavity). Nicom ® may be a useful monitor for pediatric patients. Subjects and Methods: Pediatric patients undergoing major abdominal surgery under general anesthesia with cardiac monitoring by transesophageal Doppler (TED) were included. Continuously recorded hemodynamic variables obtained from both bioreactance and TED were compared. Data were analyzed using the Bland-Altman method. Results: A total of 113 pairs of cardiac index (CI) measurments from 16 patients were analyzed. Mean age was 59 months (95% CI: 42-75) and mean weight was 17 kg (95% CI: 15-20). In the overall population, Bland-Altman analysis revealed a bias of 0.4 L/min/m 2, precision of 1.55 L/min/m 2, limits of agreement of −1.1 to 1.9 L/min/m 2 and a percentage error of 47%. For children weighing >15 kg, results were: Bias 0.51 L/min/m 2, precision 1.17 L/min/m 2, limits of agreement −0.64 to 1.66 L/min/m 2 and percentage error 34%. Conclusion: Simultaneous CI estimations made by bioreactance and TED showed high percentage of errors that is not clinically acceptable. Bioreactance cannot be considered suitable for monitoring pediatric patients.

PDF Share
  1. Giglio MT, Marucci M, Testini M, Brienza N. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: A meta-analysis of randomized controlled trials. Br J Anaesth 2009;103:637-46.
  2. Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM. Perioperative fluid management strategies in major surgery: A stratified meta-analysis. Anesth Analg 2012;114:640-51.
  3. Abbas SM, Hill AG. Systematic review of the literature for the use of oesophageal Doppler monitor for fluid replacement in major abdominal surgery. Anaesthesia 2008;63:44-51.
  4. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 2003;348:5-14.
  5. Mayer J, Boldt J, Mengistu AM, Röhm KD, Suttner S. Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: A randomized, controlled trial. Crit Care 2010;14:R18.
  6. Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO Jr, Michard F. Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: A pilot randomized controlled trial. Crit Care 2007;11:R100.
  7. Funk DJ, Moretti EW, Gan TJ. Minimally invasive cardiac output monitoring in the perioperative setting. Anesth Analg 2009;108:887-97.
  8. Peyton PJ, Chong SW. Minimally invasive measurement of cardiac output during surgery and critical care: A meta-analysis of accuracy and precision. Anesthesiology 2010;113:1220-35.
  9. Tibby SM, Hatherill M, Durward A, Murdoch IA. Are transoesophageal Doppler parameters a reliable guide to paediatric haemodynamic status and fluid management? Intensive Care Med 2001;27:201-5.
  10. Brissaud O, Guichoux J, Villega F, Orliaguet G. What non invasive haemodynamic assessment in paediatric intensive care unit in 2009? Ann Fr Anesth Reanim 2010;29:233-41.
  11. Keren H, Burkhoff D, Squara P. Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance. Am J Physiol Heart Circ Physiol 2007;293:H583-9.
  12. Raval NY, Squara P, Cleman M, Yalamanchili K, Winklmaier M, Burkhoff D. Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique. J Clin Monit Comput 2008;22:113-9.
  13. Marqué S, Cariou A, Chiche JD, Squara P. Comparison between Flotrac-Vigileo and bioreactance, a totally noninvasive method for cardiac output monitoring. Crit Care 2009;13:R73.
  14. Squara P, Rotcajg D, Denjean D, Estagnasie P, Brusset A. Comparison of monitoring performance of Bioreactance vs. pulse contour during lung recruitment maneuvers. Crit Care 2009;13:R125.
  15. Ballestero Y, López-Herce J, Urbano J, Solana MJ, Botrán M, Bellón JM, et al. Measurement of cardiac output in children by bioreactance. Pediatr Cardiol 2011;32:469-72.
  16. Weisz DE, Jain A, McNamara PJ, EL-Khuffash A. Non-invasive cardiac output monitoring in neonates using bioreactance: A comparison with echocardiography. Neonatology 2012;102:61-7.
  17. Ballestero Y, Urbano J, López-Herce J, Solana MJ, Botrán M, Vinciguerra D, et al. Pulmonary arterial thermodilution, femoral arterial thermodilution and bioreactance cardiac output monitoring in a pediatric hemorrhagic hypovolemic shock model. Resuscitation 2012;83:125-9.
  18. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307-10.
  19. Squara P, Cecconi M, Rhodes A, Singer M, Chiche JD. Tracking changes in cardiac output: Methodological considerations for the validation of monitoring devices. Intensive Care Med 2009;35:1801-8.
  20. Schober P, Loer SA, Schwarte LA. Perioperative hemodynamic monitoring with transesophageal Doppler technology. Anesth Analg 2009;109:340-53.
  21. Tibby SM, Hatherill M, Murdoch IA. Use of transesophageal Doppler ultrasonography in ventilated pediatric patients: Derivation of cardiac output. Crit Care Med 2000;28:2045-50.
  22. Schubert S, Schmitz T, Weiss M, Nagdyman N, Huebler M, Alexi-Meskishvili V, et al. Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: Evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput 2008;22:299-307.
  23. Singer M, Clarke J, Bennett ED. Continuous hemodynamic monitoring by esophageal Doppler. Crit Care Med 1989;17:447-52.
  24. Stawicki SP, Hoff WS, Cipolla J, deQuevedo R. Use of non-invasive esophageal echo-Doppler system in the ICU: A practical experience. J Trauma 2005;59:506-7.
  25. Chandan GS, Hull JM. Incorrectly placed oesophageal Doppler probe. Anaesthesia 2004;59:723.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.