Chinese Pediatric USCOM values
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Transcript of Chinese Pediatric USCOM values
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Reference ranges for cardiovascular indices for adolescents derived using
the Ultrasonic Cardiac Output Monitor (USCOM)
Cattermole GN, Ho GYL, Mak PSK, Graham CA, Rainer TH.
July 2011
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Disclosure
• Accommodation for conference provided by Pacific Medical Systems (distributors of USCOM)
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USCOM
Ultrasonic cardiac output monitor
Rapid non-invasive measurement of central haemodynamic indices:
• Cardiac output (CO)• Stroke volume (SV)• Systemic vascular resistance (SVR)
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Suprasternal transducer
position
Operation
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Screenshot
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Reference ranges• Based on unpublished data
from 500 healthy subjects in rural Australian community
• 52 aged 2-11• 32 aged 12-16
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Previous work
Resuscitation 2010;81:1105-1110First presented as an abstract at ACEM 2009, Busan, Korea
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Objectives
1. To derive reference ranges for heart rate (HR), cardiac output and index (CO, CI), stroke volume and index (SV, SVI) and systemic vascular resistance and index (SVR, SVRI) in Chinese adolescents in Hong Kong using USCOM.
2. To compare these ranges with those from Australia.
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Subjects
4 schools
590 subjects (49% male)
Mean age (SD): 15.7 (2.1) years
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MeasurementsHeight and weight Blood pressure USCOM
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Centile curves
Centile curves (2.5, 10, 50, 90, 97.5)
SV
(m
l)
Age (years)
0
20
40
60
80
100
120
10 11 12 13 14 15 16 17 18 19 20
Stroke Volume
CO
(l.m
in-1
)
Age (years)
0
1
2
3
4
5
6
7
8
9
10
11
10 11 12 13 14 15 16 17 18 19 20
Cardiac Output
SV
R (
d.s
.cm
-5)
Age (years)
0
500
1000
1500
2000
2500
10 12 14 16 18 20
SVR
SV
I (m
l.m-2
)
Age (years)
20
30
40
50
60
70
80
90
10 11 12 13 14 15 16 17 18 19 20
Stroke Volume Index
CI
(l.m
in-1
.m-2
)
Age (years)
0
1
2
3
4
5
6
7
8
10 11 12 13 14 15 16 17 18 19 20
Cardiac Index
SV
RI
(d.s
.cm
-5.m
2)
Age (years)
0
1000
2000
3000
4000
10 12 14 16 18 20
SVRI
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Means, ranges (+/- 2sd)12 13 14 15 16 17 18
SV, mL75.4
(45.2 – 105.6)79.6
(45.5 -113.7)81.5
(47.0 – 116.1)78.8
(42.9 – 114.8)77.3
(46.1 – 108.4)79.2
(47.7 – 110.6)80.2
(45.5 – 114.8)
SVI, mL.m-2 57.7 (38.9 – 76.6)
54.4 (33.8 – 74.9)
53.3 (32.3 – 74.4)
49.0 (28.8 – 69.2)
47.5 (26.4 – 68.6)
49.9 (30.8 – 69.0)
29.6 (49.3 – 68.9)
CO, L.min-1 6.1 (3.7 – 8.5)
6.5 (3.3 – 9.7)
6.7 (3.1 – 10.3)
6.1 (2.6 – 9.6)
5.8 (3.1 – 8.5)
6.1 (3.2 – 9.0)
5.8 (2.9 – 8.7)
CI L.min-1.m-2 4.7 (3.0 – 6.4)
4.4 (2.4 – 6.4)
4.4 (2.1 – 6.6)
3.8 (1.8 – 5.8)
3.6 (1.7 – 5.4)
3.9 (1.8 – 5.9)
3.6 (1.9 – 5.3)
SVR d.s.cm-5 1043 (560 – 1527)
1019 (536 – 1503)
1090 (447 – 1733)
1168 (412 – 1923)
1250 (597 – 1902)
1158 (476 – 1839)
1229 (613 – 1845)
SVRI d.s.cm-
5.m2
1347 (747 – 1947)
1487 (657 – 2318)
1666 (630 – 2701)
1867 (658 – 3077)
2116 (247 – 3986)
1859 (555 – 3164)
1988 (833 – 3144)
MAP, mmHg76.4
(59.0 – 93.7)77.2
(62.3 – 92.1)84.5
(64.2 – 104.8)81.3
(60.0 – 102.6)85.6
(67.0 – 104.3)82.4
(62.2 – 102.7)83.0
(62.0 – 103.9)
HR, min-1 86.0 (62.2 – 109.9)
87.7 (58.2 – 117.2)
85.4 (54.7 – 116.1)
81.0 (52.9 – 109.1)
80.0 (47.1 – 112.9)
80.7 (51.3 – 110.2)
75.2(44.9 – 105.5)
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Australian Comparison
Australian (n=32)
Chinese (n=360) p
Stroke Volume Index (ml.m-2) 54
(7)52.6
(10.8) 0.37
Cardiac Index (l.min-1.m-2) 4.1
(0.5)4.2 (1.1) 0.62
SVRI(d.s.cm-5.m2)
1748(324)
1685(634) 0.10
Means (sd), t-testSubjects aged 12-16 years old
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Other results
• There was poor correlation between age and cardiovascular parameters.
• SV correlated weakly with weight and height, and was significantly higher in boys than in girls.
• In the group of 12-18 year olds, parameters were normally distributed.
• Inter-observer reliability of USCOM measurements was very good.
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Reference ranges
Age SVI CI SVRI(years) (ml.m-2) (l.min-1.m-2) (d.s.cm-5.m2)
1-2 31-55 3.5-6.5 750-1600
3-4 37-67 3.6-7.1 750-1700
5-11 42-76 3.3-6.9 910-2000
12-18 30-70 2.0-6.0 510-3000
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Conclusion
• This is the only study to derive reference ranges for cardiovascular indices for Chinese adolescents, and the largest such study in any population.
• We hope that the use of these values will improve the diagnosis, treatment, management and monitoring of adolescent patients in emergency departments.
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Thanks to…The staff and children from participating schools in Shatin