Non-Invasive Venous Waveform Analysis (NIVA) for Volume Assessment During Complex Cranial Vault Reconstruction: A Proof-of-concept Study in Children

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Jul 9

PMID 32640004

Citations 3

Authors

Jenna H Sobey

Srijaya K Reddy

Kyle M Hocking

Monica E Polcz

Christy M Guth

Cameron Schlegel

Jon Whitfield

Susan S Eagle

Colleen M Brophy

Bret D Alvis

Affiliations

Soon will be listed here.

Abstract

Background: Non-Invasive Venous waveform Analysis (NIVA) is novel technology that captures and analyzes changes in venous waveforms from a piezoelectric sensor on the wrist for hemodynamic volume assessment. Complex cranial vault reconstruction is performed in children with craniosynostosis and is associated with extensive blood loss, potential life-threatening risks, and significant morbidity. In this preliminary study, we hypothesized that NIVA will provide a reliable, non-invasive, quantitative assessment of intravascular volume changes in children undergoing complex cranial vault reconstruction.

Objective: To present proof-of-concept results of a novel technology in the pediatric population.

Methods: The NIVA prototype was placed on each subject's wrist, and venous waveforms were collected intraoperatively. Estimated blood loss and fluid/blood product administration were recorded in real time. Venous waveforms were analyzed into a NIVA value and then correlated, along with mean arterial pressure (MAP), to volume changes. Concordance was quantified to determine if the direction of change in volume was similar to the direction of change in MAP or change in NIVA.

Results: Of 18 patients enrolled, 14 had usable venous waveforms, and there was a significant correlation between change in NIVA value and change in volume. Change in MAP did not correlate with change in volume. The concordance between change in MAP and change in volume was less than the concordance between change in NIVA and change in volume.

Conclusion: NIVA values correlate more closely to intravascular volume changes in pediatric craniofacial patients than MAP. This initial study suggests that NIVA is a potential safe, reliable, non-invasive quantitative method of measuring intravascular volume changes for children undergoing surgery.

Citing Articles

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Respiratory Non-Invasive Venous Waveform Analysis for Assessment of Respiratory Distress in Coronavirus Disease 2019 Patients: An Observational Study.

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References

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B . Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2002; 345(19):1368-77. DOI: 10.1056/NEJMoa010307. View

Tibby S, Hatherill M, Durward A, Murdoch I . Are transoesophageal Doppler parameters a reliable guide to paediatric haemodynamic status and fluid management?. Intensive Care Med. 2001; 27(1):201-5. DOI: 10.1007/s001340000795. View

Bhananker S, Ramamoorthy C, Geiduschek J, Posner K, Domino K, Haberkern C . Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry. Anesth Analg. 2007; 105(2):344-50. DOI: 10.1213/01.ane.0000268712.00756.dd. View

Hocking K, Sileshi B, Baudenbacher F, Boyer R, Kohorst K, Brophy C . Peripheral Venous Waveform Analysis for Detecting Hemorrhage and Iatrogenic Volume Overload in a Porcine Model. Shock. 2016; 46(4):447-52. DOI: 10.1097/SHK.0000000000000615. View

Osthaus W, Huber D, Beck C, Roehler A, Marx G, Hecker H . Correlation of oxygen delivery with central venous oxygen saturation, mean arterial pressure and heart rate in piglets. Paediatr Anaesth. 2006; 16(9):944-7. DOI: 10.1111/j.1460-9592.2006.01905.x. View

Kluckow M, Evans N . Relationship between blood pressure and cardiac output in preterm infants requiring mechanical ventilation. J Pediatr. 1996; 129(4):506-12. DOI: 10.1016/s0022-3476(96)70114-2. View

Jimenez N, Posner K, Cheney F, Caplan R, Lee L, Domino K . An update on pediatric anesthesia liability: a closed claims analysis. Anesth Analg. 2006; 104(1):147-53. DOI: 10.1213/01.ane.0000246813.04771.03. View

Tibby S, Hatherill M, Marsh M, Murdoch I . Clinicians' abilities to estimate cardiac index in ventilated children and infants. Arch Dis Child. 1998; 77(6):516-8. PMC: 1717412. DOI: 10.1136/adc.77.6.516. View

Martin-Flores M, Cisternas A, Gleed R . Changes in blood volume indicators and dynamic indicators measured with transpulmonary ultrasound velocity during blood depletion and repletion in a neonatal swine model. Paediatr Anaesth. 2017; 27(11):1136-1141. DOI: 10.1111/pan.13232. View

10.

Egan J, Festa M, Cole A, Nunn G, Gillis J, Winlaw D . Clinical assessment of cardiac performance in infants and children following cardiac surgery. Intensive Care Med. 2005; 31(4):568-73. DOI: 10.1007/s00134-005-2569-5. View

11.

Alvis B, Polcz M, Huston J, Hopper T, Leisy P, Mishra K . Observational Study of Noninvasive Venous Waveform Analysis to Assess Intracardiac Filling Pressures During Right Heart Catheterization. J Card Fail. 2019; 26(2):136-141. DOI: 10.1016/j.cardfail.2019.09.009. View

12.

Choi D, Kwak H, Park H, Kim Y, Choi C, Lee J . Respiratory variation in aortic blood flow velocity as a predictor of fluid responsiveness in children after repair of ventricular septal defect. Pediatr Cardiol. 2010; 31(8):1166-70. DOI: 10.1007/s00246-010-9776-8. View

13.

Han Y, Carcillo J, Dragotta M, Bills D, Watson R, Westerman M . Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003; 112(4):793-9. DOI: 10.1542/peds.112.4.793. View

14.

Renner J, Broch O, Gruenewald M, Scheewe J, Francksen H, Jung O . Non-invasive prediction of fluid responsiveness in infants using pleth variability index. Anaesthesia. 2011; 66(7):582-9. DOI: 10.1111/j.1365-2044.2011.06715.x. View

15.

Byon H, Lim C, Lee J, Park Y, Kim H, Kim C . Prediction of fluid responsiveness in mechanically ventilated children undergoing neurosurgery. Br J Anaesth. 2012; 110(4):586-91. DOI: 10.1093/bja/aes467. View

16.

Durand P, Chevret L, Essouri S, Haas V, Devictor D . Respiratory variations in aortic blood flow predict fluid responsiveness in ventilated children. Intensive Care Med. 2008; 34(5):888-94. DOI: 10.1007/s00134-008-1021-z. View

17.

Tibby S, Hatherill M, Murdoch I . Use of transesophageal Doppler ultrasonography in ventilated pediatric patients: derivation of cardiac output. Crit Care Med. 2000; 28(6):2045-50. DOI: 10.1097/00003246-200006000-00061. View

18.

Tran H, Froese N, Dumont G, Lim J, Ansermino J . Variation in blood pressure as a guide to volume loading in children following cardiopulmonary bypass. J Clin Monit Comput. 2006; 21(1):1-6. DOI: 10.1007/s10877-006-9051-y. View

19.

Senzaki H, Akagi M, Hishi T, Ishizawa A, Yanagisawa M, Masutani S . Age-associated changes in arterial elastic properties in children. Eur J Pediatr. 2002; 161(10):547-51. DOI: 10.1007/s00431-002-1025-6. View

20.

Gan H, Cannesson M, Chandler J, Ansermino J . Predicting fluid responsiveness in children: a systematic review. Anesth Analg. 2013; 117(6):1380-92. DOI: 10.1213/ANE.0b013e3182a9557e. View