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Paediatric Use of ODM+

Paediatrics

The ODM+ is the world’s first dedicated paediatric cardiac function and fluid status monitor, to measure both flow and pressure.

ODM+ can be safely used to guide fluid management and monitor haemodynamic changes in paediatric patients, using the minimally invasive paediatric Doppler probe (KDP72), placed orally in sedated or anaesthetised patients. The optional connection of an arterial line for pressure monitoring mode is now available, offering quick, easy calibration at the touch of a button.

Designed for surgical and intensive care applications, ODM+ and the paediatric probe can be utilised in the following instances:

  • Sepsis
  • Major abdominal surgery
  • Laparoscopic surgery
  • Transplant procedures
  • Cardiac procedures
  • Trauma procedures
  • Spinal surgery

A paediatric specific nomogram, based on patient height, takes into consideration the unique anatomy and physiology of the paediatric population. As with adult patients, the calibrated Pressure Monitoring Mode allows for extended continuous monitoring in paediatric patients.

The ODM+ and paediatric probe are suitable for patients:

  • ≥ 3kg
  • ≥ 50cm tall
  • < 16 years old

For a list of studies validating the ODM in paediatric patients, click here

To access the Paediatric e-Learning module, click here

Paediatric Case Studies using the CardioQ-ODM+

Postoperative Warming

Screenshot 1

3 week old baby, Wt 3.6 kg (8 lb), Ht 58 cm (23 in), BSA 0.22 m2. Postoperative bowel resection.

A good clepow s1ar Doppler signal is defined by the tidy green line around the waveform, orange/white around waveform edge (more white along downslope) with a dark center and correct arrow placement. Gain was adequate.

The baby had fluid management in the operating theatre guided by the ODM+ and was now in intensive care for postoperative monitoring. FTc is reduced and there is a small respiratory swing on the waveform. HR may be acceptable.

Screenshot 2

FTc, SV, pow s2PV, CO/I are increasing. The baby feels warmer to touch. This may indicate a reduction in afterload due to warming after surgery. However, since the respiratory swing continued, there may now be a slight relative hypovolaemia and some fluid was given.

 

 

Screenshot 3

Following pow s3the fluid, FTc, SV, PV, CO/I are increasing. HR may be increasing for several reasons; eg. further relative hypovolaemia as the baby continues to warm or pain/distress.

 

 

 

Summary

The ODM+ can be used safely to assess cardiac function and its responses to interventions. It is the only technology precise enough to see small changes in flow. Flow is very responsive to even small changes in circulating blood volume as well as changes in arterial compliance.

Abbreviations: BP – blood pressure. BSA – body surface area. CO/I – cardiac output/index. CVP – central venous pressure FTc – flow time corrected. HR – heart rate. Ht – height. IV – intravenous. ODM+ – oesophageal Doppler monitor. PV – peak velocity. SV/I – stroke volume/index. Wt – weight.

Covert Haemorrhage and Response to Fluid

Screenshot 1

3 year old child. Wt 15 kg (33 lb), Ht 108 cm (42.5 in), BSA 0.67m2. Intraoperative. Laparotomy and resection of abdominal neuroblastoma. General anaesthetic used and ventilated.

3yr s1A good clear Doppler signal is defined by the tidy green line around the waveform, orange/white around waveform edge (more white along downslope) with a dark center and correct arrow placement. Gain was adequate.

At this point in surgery, CI, FTc and PV had reduced from previous results possibly indicating an increasing afterload, yet the urine output and BP remained stable.

 

 

Screenshot 2

Wh3yrs s2ilst monitoring the child, 5 minutes later, the results continued to deteriorate, and blood was then seen in the suction canister. SV, FTc, PV and CO/I decrease suggesting further increase in afterload probably as a result of compensation to the drop in preload, together with an increase in HR. The waveform has also become smaller in height and width. BP at this point had also started to decrease. Fluid was given, Hb checked and a blood transfusion commenced.

 

Screenshot 3

Half a3yrs s3n hour later following fluid and blood, SV, FTc, PV and CO/I have increased as preload increased as well as a reduction in afterload. HR has also reduced and the waveform has increased in height and width.

 

 

Summary

In this scenario, the ODM+ indicated covert bleeding.

The ODM+ is the only technology precise enough to see small changes in flow. Flow is very responsive to changes in circulating blood volume, whereas pressure can often be maintained due to compensation. Hypovolaemia is unlikely to be missed when flow is measured by the ODM+ because of its superior precision. Fluid can then be given safely in small amounts, thus preventing over or under filling of the patient.

Abbreviations: BP – blood pressure. BSA – body surface area. CO/I – cardiac output/index. CVP – central venous pressure FTc – flow time corrected. HR – heart rate. Ht – height. IV – intravenous. ODM+ – oesophageal Doppler monitor. PV – peak velocity. SV/I – stroke volume/index. Wt – weight.

Postoperative Trauma

Screenshot 1

14 year old child. Wt 30 kg (66 lb), Ht 151 cm (59.5 in), BSA 1.10 m2. Multiple trauma following road traffic accident – suffered massive haemoperitoneum, chest trauma with pneumothorax, facial and abdominal trauma. Postoperative monitoring in intensive care following facial suturing, splenectomy and exploration of blunt trauma to liver. Ventilated and sedated.

A good 14yrs s1clear Doppler signal is defined by the tidy green line around the waveform, orange/white around waveform edge (more white along downslope) with a dark center and correct arrow placement. Gain was adequate.

BP at this stage was reduced. FTc is reduced probably indicating an increased afterload – the most common cause being hypovolaemia. The clinician gave a rapid fluid challenge.

Screenshot 2

Follo14yrs s2wing a fluid challenge, the SV has increased by more than 10% indicating fluid responsiveness. CO/I is unchanged, but FTc has also increased indicating a reduction in afterload. Further fluid was then given.

 

 

Screenshot 3

SV i14yrs s3ncreased again by more than 10%. FTc, PV and CO/I also increase while HR reduces.

BP however remained low and a dose of epinephrine was then given.

 

 

Screenshot 4

Foll14yrs s4owing the epinephrine, flow results continue to increase and BP also increased.

 

 

 

 

Summary

The ODM+ can be used safely to assess cardiac function and how it responds to interventions. It is the only technology precise enough to see small changes in flow. Flow is very responsive to even small changes in circulating blood volume as well as changes in arterial compliance.

Abbreviations: BP – blood pressure. BSA – body surface area. CO/I – cardiac output/index. CVP – central venous pressure FTc – flow time corrected. HR – heart rate. Ht – height. IV – intravenous. ODM+ – oesophageal Doppler monitor. PV – peak velocity. SV/I – stroke volume/index. Wt – weight.