Non-invasive hemodynamic monitoring guides resuscitation in pediatric meningococcemia
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A 2-year-old boy presented with fever, vomiting, and lethargy. He was drowsy, tachycardic, hypotensive, and had a rash. Fluid resuscitation and antibiotics were given. USCOM monitoring showed an initially low cardiac index and high systemic vascular resistance, but improving hemodynamics over time with treatment.
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Non-invasive hemodynamic monitoring guides resuscitation in pediatric meningococcemia
- 1. Meningococcemia - Pediatric History 2 y/o boy. Taken to Pediatrician with history of sudden onset of fever, vomiting and lethargy for 4 hours. Referred to walk-in clinic at hospital. Presentation Drowsy and pale, dark rings around eyes Temperature 38.7o C CVS: HR 180 bpm, BP 70/26 mmHg Cool peripheries, capillary refill time 5 sec RS: RR 54 ipm, dyspnea, cyanosis SaO2 100% in oxygen NS: GCS 10 then 9, no neck stiffness Fine blanching rash on abdomen/chest. Petechial spot on the face. www.uscom.com.au The Measure of Life
- 2. Meningococcemia - Pediatric Distance blood cell travels / minute Treatment Parameter Base Age wise Fluid bolus 40 ml/kg Measure norms Epinephrine 0.15 mcg/kg/min MD (m/min) 12 18-30 Hypodynamic SVI (ml/m2) 30 40-55 SV (ml/kg) 1.2 1.5-2.4 SVV (%) 45 <15 Hypovolemia / FTc (ms) 278 300-375 Fluid responsive HR 180 85-115 SVRI (d.s.cm/m2) 1120 1000-1600 Normal Systemic SVR (d.s.cm) 1889 1500-2000 Vascular Resistance CI (l/min/m2) 2.8 3.5-5.0 CO (l/min) 2.0 2.5-4.0 Low Cardiac Index Vpk (ms) 0.8 1.1-1.6 www.uscom.com.au The Measure of Life
- 3. Meningococcemia - Pediatric 60 minutes Sedated, mechanical ventilation Afebrile CVS: HR 180 - 150 bpm, BP 70/26 - 90/30 mmHg Capillary refill time 5 - 3 sec Acidosis improved SaO2 100% in oxygen www.uscom.com.au The Measure of Life
- 4. Meningococcemia - Pediatric Treatment Parameter Base 60mins Age wise Fluid bolus 20 ml/kg norms Norepinephrine 0.1 mcg/kg/min MD (m/min) 12 21 18-30 Normodynamic SVI (ml/m2) 30 50 40-55 SV (ml/kg) 1.2 20 1.5-2.4 SVV (%) 45 38 <15 Hypovolemia / FTc (ms) 278 312 300-375 Fluid responsive HR 180 150 85-115 SVRI (d.s.cm/m2) 1120 690 1000-1600 Low Systemic SVR (d.s.cm) 1889 899 1500-2000 Vascular Resistance CI (l/min/m2) 2.8 3.8 3.5-5.0 CO (l/min) 2.0 2.6 2.5-4.0 Adequate Vpk (ms) 0.8 1.3 1.1-1.6 Cardiac Index www.uscom.com.au The Measure of Life
- 5. Meningococcemia - Pediatric Sedated, mechanical ventilation Afebrile CVS: HR 150 - 115 bpm, BP 90/30 - 100/48 mmHg Capillary refill time 3 - < 2 sec No acidosis www.uscom.com.au The Measure of Life
- 6. Meningococcemia - Pediatric Treatment Parameter Base 60min 90min Age wise Fluid bolus 20 ml/kg norms Norepinephrine 0.2 MD (m/min) 12 21 32 18-30 mcg/kg/min SVI (ml/m2) 30 50 58 40-55 SV (ml/kg) 1.2 20 2.6 1.5-2.4 SVV (%) 45 38 19 <15 Mild volume FTc (ms) 278 312 310 300-375 deficit and HR 180 150 112 85-115 vasodilation SVRI (d.s.cm/m2) 1120 690 897 1000-1600 SVR (d.s.cm) 1889 899 1324 1500-2000 CI (l/min/m2) 2.8 3.8 4.6 3.5-5.0 CO (l/min) 2.0 2.6 3.8 2.5-4.0 Vpk (ms) 0.8 1.3 1.5 1.1-1.6 www.uscom.com.au The Measure of Life
- 7. Meningococcemia - Pediatric Summary Paracetamol and appropriate antibiotics for meningococcemia were given within the first hour. Hemodynamics monitored as appropriate treatment administered. Conclusion USCOM gave guidance during the resuscitation, in a very rapid way, without any invasive procedure. www.uscom.com.au The Measure of Life
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- Low MD - 12 (Typical 18-30) = Hypodynamic circulationLow SVI & High SVV = probably HypovolemiaNormal SVRI â 1120 (Typical 1000-1600)Low CI â 2.8 (Typical 3.5-5.0)Low Vpk â 0.8 (Typical 1.1-1.6)Epinephrine (also known as adrenaline) is used as a drug to treat cardiac arrest and other cardiac dysrhythmias resulting in diminished or absent cardiac output. Its actions are to increase peripheral resistance via α1receptor-dependent vasoconstriction and to increase cardiac output via its binding to ÎČ1 receptors.http://en.wikipedia.org/wiki/Epinephrine
- Normal MD - 21 (Typical 18-30) =Normodynamic circulationNormal SVI 50 & Normal-Low FTc 312 = probably mild HypovolemiaLowSVRI â 690 (Typical 1000-1600) = Relative HypovolemiaNormal CI â 3.8 (Typical 3.5-5.0)Normal Vpk â 1.3 (Typical 1.1-1.6)
- Normal MD - 32 (Typical 18-30) =Normodynamic circulationNormal SVI 58, CI 4.6 & FTc 310 = Relative HypovolemiaLowSVRI â 897 (Typical 1000-1600) = HypovolemiaNormal Vpk â 1.5 (Typical 1.1-1.6)