Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Congenital heart disease (n=72). Intervention: Point-of-care skin ultrasound vs. Healthy controls / Baseline measurements. Primary outcome: Intra-user variability of subcutaneous tissue thickness measurements (ICC 0.95, 95% CI 0.946-0.954).

Q: What does this research mean for the field?

Point-of-care skin ultrasound is a reliable and reproducible method with high intra- and inter-user agreement for quantifying subcutaneous edema and extravascular fluid overload in infants undergoing cardiac surgery. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jessica N. Persson; Jacqueline Holstein; Lori Silveira; Aimee Irons; Taufiek Konrad Rajab; James Jaggers; Mark Twite; Carly Scahill; Mary Kohn; Christine Gold; Jesse Davidson

doi:10.3389/fped.2021.727571

August 23, 2021Frontiers in PediatricsOpen Access

Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

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Key result

Point-of-care skin ultrasound demonstrates excellent reliability for measuring subcutaneous tissue thickness in neonates and infants.

ICC 0.95
95% CI 0.946-0.954
n=72

Figures

Why the study?

Fluid overload is common after pediatric cardiac surgery and linked to morbidity and mortality, but no gold standard exists for assessing fluid status.

Does point-of-care ultrasound reliably measure subcutaneous tissue thickness to quantify extravascular fluid overload in neonates and infants undergoing cardiac surgery?

Study Design

Type

Cohort (n=72)

Multicenter

No

Structured PICO

Does point-of-care ultrasound reliably measure subcutaneous tissue thickness to quantify extravascular fluid overload in neonates and infants undergoing cardiac surgery?

P

Population

72 neonates and infants, including 50 healthy controls and 22 with congenital heart disease undergoing cardiac surgery, evaluated for perioperative edema using point-of-care ultrasound.

E

Exposure

Point-of-care skin ultrasound using a broadband linear array transducer on four body sites (upper anterior chest, lateral chest, lateral abdomen, anterior thigh) performed at baseline and daily from post-operative day 1 to 3 (or up to day 5 if open chest).

C

Comparator

Healthy term neonatal controls who underwent skin ultrasound at a single baseline time point.

O

Outcome

Validation of point-of-care ultrasound for the measurement of subcutaneous tissue thickness (skin edema) and assessment of intra- and inter-user variability.surrogate

Main Result

Effect estimate: ICC 0.95 (95% CI 0.946-0.954)

Point-of-care skin ultrasound is a reproducible and reliable non-invasive method to quantify extravascular fluid overload (edema) in neonates and infants following cardiac surgery.

Limitations

Small sample size, especially in the surgical cohorts
Single center nature of the study limits overall generalizability
Technical challenges including large ultrasound probe relative to subject size, unstable or unsedated subjects, and interfering lines/tubes
Small sample size requiring a larger study to better define the quality and quantity of subcutaneous tissue in neonates with CHD compared to healthy neonates

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Implication

POCUS skin edema measurement may aid postoperative fluid assessment in infants; leaves open clinical adoption pending outcome validation.

Abstract

Purpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in infants and assess the intra- and inter-user variability. Methods: Prospective cohort study of neonates (≤30 d/o) and infants (31 d/o to 12 m/o) undergoing cardiac surgery and neonatal controls. Skin ultrasound was performed on four body sites at baseline and daily post-operatively through post-operative day (POD) 3. Subcutaneous tissue depth was manually measured. Intra- and inter-user variability was assessed using intraclass correlation coefficient (ICC). Results: Fifty control and 22 surgical subjects underwent skin ultrasound. There was no difference between baseline surgical and control neonates. Subcutaneous tissue increased in neonates starting POD 1 with minimal improvement by POD 3. In infants, this pattern was less pronounced with near resolution by POD 3. Intra-user variability was excellent (ICC 0.95). Inter-user variability was very good (ICC 0.82). Conclusion: Point-of-care skin ultrasound is a reproducible and reliable method to measure subcutaneous tissue in infants with and without congenital heart disease. Acute increases in subcutaneous tissue suggests development of skin edema, consistent with extravascular fluid overload. There is evidence of skin edema starting POD 1 in all subjects with no substantial improvement by POD 3 in neonates. Point-of-care ultrasound could be an objective way to measure extravascular fluid overload in infants. Further research is needed to determine how extravascular fluid overload correlates to clinical outcomes.

Discussion

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Cite This Study

Persson et al. (2021) conducted a cohort in Congenital heart disease (n=72). Point-of-care skin ultrasound vs. Healthy controls / Baseline measurements was evaluated on Intra-user variability of subcutaneous tissue thickness measurements (ICC 0.95, 95% CI 0.946-0.954). Point-of-care skin ultrasound demonstrated excellent intra-user reliability and very good inter-user reliability for measuring subcutaneous tissue thickness in neonates and infants.

synapsesocial.com/papers/6aa840965d9410427ecdef54 https://doi.org/10.3389/fped.2021.727571

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Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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