Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 6:9:100067.
doi: 10.1016/j.sipas.2022.100067. eCollection 2022 Jun.

Measurement of intravascular volume status in infants undergoing cranial vault reconstruction for craniosynostosis

Jenny Stevens  1 , Ryan Phillips  1 , Peter Mourani  2 , Emily Cooper  3 , Alexander M Kaizer  4 , Matt Wilder  2 , Brooke French  5 , Corbett Wilkinson  6 , Steven Moulton  1 , S Christopher Derderian  1
Affiliations

Measurement of intravascular volume status in infants undergoing cranial vault reconstruction for craniosynostosis

Jenny Stevens et al. Surg Pract Sci. .

Abstract

Introduction: Determining the need, optimal timing, amount, and type of fluid for volume expansion in hypovolemic infants is challenging, due to their small intravascular volumes and robust compensatory reserve. To assess markers of fluid responsiveness in hypovolemic infants, we studied those undergoing cranial vault reconstructive surgery-a procedure associated with significant blood loss. We aimed to determine the ability of the Compensatory Reserve Index (CRI) monitor, which provides a continuous, individual-specific, beat-to-beat estimate of central volume status, to distinguish fluid responders from non-responders.

Methods: A prospective observational pilot study of infants undergoing cranial vault reconstructive surgery for craniosynostosis was performed from May 2019-January 2020. A CardioQ-Esophageal Doppler Monitor, which measures changes in peak aortic velocity, was utilized to distinguish fluid responders- defined as those who demonstrated an increase in peak aortic velocity > 15% following a crystalloid bolus (10 mL/kg). Several static and dynamic variables were analyzed, including the CRI monitor. Each variable's performance was compared using area under the receiver operator curves (AUC), adjusting for age and bolus volume.

Results: Twenty subjects were included and a total of 23 boluses (19 crystalloid and 4 blood) were administered. Of all boluses, 7 (all crystalloid) were provided to fluid responders and 16 to non-responders. There were no statistically significant differences in bolus volumes or bolus durations between responders and non-responders. While adjusting for age and bolus volume, CRI performed similarly to other bedside tools to predict fluid responsiveness with an AUC of 0.7024 (95% CI = 0.459, 0.946).

Conclusion: Distinguishing infants who are fluid responders from those who are not can be challenging. CRI is a continuous, non-invasive measure that was developed using adult waveform data, yet even in very young patients is able to identify those who may benefit from additional volume expansion.

Study type: Therapeutic/Care management.

Level of evidence: Level II.

Keywords: Blood loss; Compensatory reserve index; Fluid resuscitation; Hemodynamic monitoring; Pediatric.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Institutional protocol for fluid and blood administration for infants with craniosynostosis undergoing cranial vault reconstruction.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Swan H.J., Ganz W., Forrester J., Marcus H., Diamond G., Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970;283(9):447–451. - PubMed
    1. Marik P.E., Cavallazzi R., Vasu T., Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–2647. - PubMed
    1. Marik P.E., Lemson J. Fluid responsiveness: an evolution of our understanding. Br J Anaesth. 2014;112(4):617–620. - PubMed
    1. Broyles M.G., Subramanyam S., Barker A.B., Tolwani A.J. Fluid responsiveness in the critically Ill patient. Adv Chronic Kidney Dis. 2021;28(1):20–28. - PubMed
    1. Shah M.R., Hasselblad V., Stevenson L.W., Binanay C., O'Connor C.M., Sopko G., et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA. 2005;294(13):1664–1670. - PubMed

LinkOut - more resources