Key result
Lower preloading NT-pro-BNP and higher postloading SMII predict fluid responsiveness in pediatric shock.
Why the study?
Serum NT-pro-BNP and Smith-Madigan inotropic index (SMII) correlate with myocardial function, but their role in monitoring cardiac performance during fluid resuscitation in paediatric patients needed evaluation.
Do serum NT-pro-BNP and noninvasive bedside Smith-Madigan inotropic index (SMII) discriminate fluid responsiveness in paediatric shock patients without cardiac disease?
Observational (n=70)
Attending physicians were not blinded to the USCOM parameters measured
No
Do serum NT-pro-BNP and noninvasive bedside Smith-Madigan inotropic index (SMII) discriminate fluid responsiveness in paediatric shock patients without cardiac disease?
In paediatric shock patients without structural heart disease, lower preloading serum NT-pro-BNP and higher postloading SMII are associated with positive fluid responsiveness, whereas preloading SMII is confounded by low preload conditions.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for NT-pro-BNP and SMII in paediatric shock fluid assessment; prospective validation required before clinical adoption.
Background. Mild elevation of serum amino-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is associated with myocardial dysfunction. A significantly lower Smith–Madigan inotropic index (SMII) has been shown to accurately represent cardiac contractility among heart failure subjects. We aim to monitor the effect of fluid resuscitation on cardiac function among paediatric patients by measuring serum NT-pro-BNP and SMII. Methods. This is an observational study on 70 paediatric shock patients. NT-pro-BNP and noninvasive bedside haemodynamic monitoring were done by using an ultrasonic cardiac output monitor (USCOM, USCOM, Sydney, Australia). The presence of cardiac diseases was excluded. SMII was obtained from the USCOM. An increase in the stroke volume index (SVI) of ≥15% indicates fluid responders. Measurements were taken before and after fluid loading. Results. Preloading NT-pro-BNP and SMII category were significantly different between the fluid responsiveness group, p = 0.001 and p = 0.004 , respectively. Higher median NT-pro-BNP (preloading NT-pro-BNP of 1175.00 (254.50–9965.00) ng/mL vs. 196.00 (65.00–509.00) ng/mL, p = 0.002 ) was associated with fluid nonresponders (subjects >12 months old). Preloading NT-pro-BNP <242.5 ng/mL was associated with fluid responders (AUC: 0.768 (0.615–0.921), p = 0.003 ), 82.1% sensitivity, and 68.7% specificity for subjects >12 years old. Delta NT-pro-BNP in fluid responders (15.00 (−16.00–950.00) ng/mL) did not differ from fluid nonresponders (505.00 (−797.00–1600.00) ng/mL), p = 0.456 . Postloading SMII >1.25 W·m−2 was associated with fluid responders (AUC: 0.683 (0.553–0.813), p = 0.011), 61.9% sensitivity, and 66.7% specificity, but not preloading SMII. Fluid responders had a higher mean postloading SMII compared to nonresponders (1.36 ± 0.38 vs. 1.10 ± 0.34, p = 0.006 ). Conclusion. Higher NT-pro-BNP and lower SMII in the absence of cardiac diseases were associated with poor response to fluid loading. The SMII is affected by low preload conditions.
No takes yet. Share an insight, caveat, or question.
Pudjiadi et al. (2021) conducted an observational in Paediatric shock indicated for fluid resuscitation (n=70). Serum NT-pro-BNP and Smith-Madigan inotropic index (SMII) via USCOM during fluid resuscitation vs. Fluid nonresponders (stroke volume index increase <15%) was evaluated on Fluid responsiveness (increase in stroke volume index [SVI] of >=15% after fluid loading) (AUC 0.768 for preloading NT-pro-BNP <242.5 ng/mL, 95% CI 0.615-0.921, p=0.003). Preloading NT-pro-BNP <242.5 ng/mL (AUC 0.768, p=0.003) and postloading SMII >1.25 W/m2 (AUC 0.683, p=0.011) discriminated fluid responders in paediatric shock.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: