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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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Chinese Pediatric USCOM values

  1. 1. Reference ranges for cardiovascularindices for adolescents derived using the Ultrasonic Cardiac Output Monitor (USCOM) Cattermole GN, Ho GYL, Mak PSK, Graham CA, Rainer TH. July 2011
  2. 2. Disclosure• Accommodation for conference provided by Pacific Medical Systems (distributors of USCOM)
  3. 3. USCOMUltrasonic cardiac output monitorRapid non-invasive measurement of central haemodynamic indices:• Cardiac output (CO)• Stroke volume (SV)• Systemic vascular resistance (SVR)
  4. 4. OperationSuprasternal transducer position
  5. 5. Screenshot
  6. 6. Reference ranges• Based on unpublished data • 52 aged 2-11 from 500 healthy subjects in rural Australian community • 32 aged 12-16
  7. 7. Previous workResuscitation 2010;81:1105-1110First presented as an abstract at ACEM 2009, Busan, Korea
  8. 8. Objectives1. 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.
  9. 9. Subjects 4 schools 590 subjects (49% male) Mean age (SD): 15.7 (2.1) years
  10. 10. MeasurementsHeight and weight Blood pressure USCOM
  11. 11. Centile curves 120 Stroke Volume 11 Cardiac Output 2500 SVR 10 100 9 2000 SVR (d.s.cm-5) 8 CO (l.min-1) 80 7 1500SV (ml) 6 60 5 1000 4 40 3 500 20 2 1 0 0 0 10 11 12 13 14 15 16 17 18 19 20 10 11 12 13 14 15 16 17 18 19 20 10 12 14 16 18 20 Age (years) Age (years) Age (years) 90 Stroke Volume 8 Cardiac Index 4000 SVRI Index 7 SVRI (d.s.cm-5.m2) 80 3000 CI (l.min-1.m-2) 70 6 SVI (ml.m-2) 60 5 2000 4 50 3 40 1000 2 30 1 0 20 10 12 14 16 18 20 10 11 12 13 14 15 16 17 18 19 20 0 10 11 12 13 14 15 16 17 18 19 20 Age (years) Age (years) Age (years) Centile curves (2.5, 10, 50, 90, 97.5)
  12. 12. Means, ranges (+/- 2sd) 12 13 14 15 16 17 18 75.4 79.6 81.5 78.8 77.3 79.2 80.2 SV, mL (45.2 – 105.6) (45.5 -113.7) (47.0 – 116.1) (42.9 – 114.8) (46.1 – 108.4) (47.7 – 110.6) (45.5 – 114.8) 57.7 54.4 53.3 49.0 47.5 49.9 29.6 SVI, mL.m-2 (38.9 – 76.6) (33.8 – 74.9) (32.3 – 74.4) (28.8 – 69.2) (26.4 – 68.6) (30.8 – 69.0) (49.3 – 68.9) 6.1 6.5 6.7 6.1 5.8 6.1 5.8 CO, L.min-1 (3.7 – 8.5) (3.3 – 9.7) (3.1 – 10.3) (2.6 – 9.6) (3.1 – 8.5) (3.2 – 9.0) (2.9 – 8.7) 4.7 4.4 4.4 3.8 3.6 3.9 3.6CI L.min-1.m-2 (3.0 – 6.4) (2.4 – 6.4) (2.1 – 6.6) (1.8 – 5.8) (1.7 – 5.4) (1.8 – 5.9) (1.9 – 5.3) 1043 1019 1090 1168 1250 1158 1229SVR d.s.cm-5 (560 – 1527) (536 – 1503) (447 – 1733) (412 – 1923) (597 – 1902) (476 – 1839) (613 – 1845)SVRI d.s.cm- 1347 1487 1666 1867 2116 1859 1988 5.m2 (747 – 1947) (657 – 2318) (630 – 2701) (658 – 3077) (247 – 3986) (555 – 3164) (833 – 3144) 76.4 77.2 84.5 81.3 85.6 82.4 83.0MAP, mmHg (59.0 – 93.7) (62.3 – 92.1) (64.2 – 104.8) (60.0 – 102.6) (67.0 – 104.3) (62.2 – 102.7) (62.0 – 103.9) 86.0 87.7 85.4 81.0 80.0 80.7 75.2 HR, min-1 (62.2 – 109.9) (58.2 – 117.2) (54.7 – 116.1) (52.9 – 109.1) (47.1 – 112.9) (51.3 – 110.2) (44.9 – 105.5)
  13. 13. Australian Comparison Australian Chinese p (n=32) (n=360) Stroke Volume Index 54 52.6 (ml.m-2) 0.37 (7) (10.8) Cardiac Index 4.1 4.2 (l.min-1.m-2) 0.62 (0.5) (1.1) SVRI 1748 1685 (d.s.cm-5.m2) 0.10 (324) (634)Subjects aged 12-16 years old Means (sd), t-test
  14. 14. 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.
  15. 15. Reference rangesAge 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 3.6-7.1 750-17005-11 42-76 3.3-6.9 910-200012-18 30-70 2.0-6.0 510-3000
  16. 16. 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.
  17. 17. Thanks to… The staff and children from participating schools in Shatin

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