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Background: This study evaluated the ability of a non-invasive cardiac output monitoring device (NICOM) to predict fluid responsiveness in paediatric patients undergoing cardiac surgery.

Methods: Children aged <5 yr undergoing congenital heart surgery were included. Once the sternum had been closed after repair of the congenital heart defect, 10 ml kg-1 colloid solution was administered for volume expansion. Transoesophageal echocardiography (TOE) was performed to measure stroke volume (SV) and respiratory variation in aortic blood flow peak velocity ([DELTA]Vpeak) before and after volume expansion. Haemodynamic and NICOM variables, including SVNICOM, stroke volume variance (SVVNICOM), cardiac index (CINICOM), and percentage change in thoracic fluid content compared with baseline (TFCd0%), were also recorded. Patients in whom the stroke volume index (SVI), measured using TOE, increased by >15% were defined as fluid responders.

Results: Twenty-nine patients were included (13 responders and 16 non-responders). Before volume expansion, only [DELTA]Vpeak differed between groups (P=0.036). The SVVNICOM, HR, and central venous pressure did not predict fluid responsiveness, but [DELTA]Vpeak did. The CINICOM was not correlated with CITOE (r=0.107, P=0.43). Using Bland-Altman analysis, the mean bias between CITOE and CINICOM was 0.89 litre min-1 m-2, with a precision of 1.14 litre min-1 m-2. Trending ability of NICOM for SVI and CI was poor when TOE was a reference method.

Conclusions: The SVVNICOM did not predict fluid responsiveness in paediatric patients during cardiac surgery. In addition, there was no correlation between CITOE and CINICOM. Fluid management guided by NICOM should be performed carefully.

Clinical trial registration: ClinicalTrials.gov NCT01996956.

(C) 2015 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.