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Ralston BH, Waberski AT, Kanter JP, Schick JW, Downing TE. Measured Oxygen Consumption During Pediatric Cardiac Catheterization is More Accurate than Assumed Oxygen Consumption. Pediatr Cardiol 2023:10.1007/s00246-023-03186-x. [PMID: 37243747 DOI: 10.1007/s00246-023-03186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/14/2023] [Indexed: 05/29/2023]
Abstract
When calculating cardiac index (C.I.) by the Fick method, oxygen consumption (VO2) is often unknown, so assumed values are typically used. This practice introduces a known source of inaccuracy into the calculation. Using a measured VO2 (mVO2) from the CARESCAPE E-sCAiOVX module provides an alternative that may improve accuracy of C.I. calculations. Our aim is to validate this measurement in a general pediatric catheterization population and compare its accuracy with assumed VO2 (aVO2). mVO2 was recorded for all patients undergoing cardiac catheterization with general anesthesia and controlled ventilation during the study period. mVO2 was compared to the reference VO2 (refVO2) determined by the reverse Fick method using cardiac MRI (cMRI) or thermodilution (TD) as a reference standard for measurement of C.I. when available. 193 VO2 measurements were obtained, including 71 with a corresponding cMRI or TD measure of cardiac index for validation. mVO2 demonstrated satisfactory concordance and correlation with the TD- or cMRI-derived refVO2 (ρc = 0.73, r2 = 0.63) with a mean bias of - 3.2% (SD ± 17.3%). Assumed VO2 demonstrated much weaker concordance and correlation with refVO2 (ρc = 0.28, r2 = 0.31) with a mean bias of + 27.5% (SD ± 30.0%). Subgroup analysis of patients < 36 months of age demonstrated that error in mVO2 was not significantly different from that observed in older patients. Many previously reported prediction models for assuming VO2 performed poorly in this younger age range. Measured oxygen consumption using the E-sCAiOVX module is significantly more accurate than assumed VO2 when compared to TD- or cMRI-derived VO2 in a pediatric catheterization lab.
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Affiliation(s)
- Bradford H Ralston
- Division of Cardiology, Children's National Hospital, Washington, DC, USA.
- Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, 900 23rd St. NW, Washington, DC, 20037, USA.
| | - Andrew T Waberski
- Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, DC, USA
| | - Joshua P Kanter
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Jacob W Schick
- Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, DC, USA
| | - Tacy E Downing
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
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Ralston BH, Willett RC, Namperumal S, Brown NM, Walsh H, Muñoz RA, Del Castillo S, Chang TP, Yurasek GK. Use of Virtual Reality for Pediatric Cardiac Critical Care Simulation. Cureus 2021; 13:e15856. [PMID: 34327083 PMCID: PMC8301287 DOI: 10.7759/cureus.15856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/07/2022] Open
Abstract
Simulation is a key component of training in the pediatric cardiac intensive care unit (CICU), a complex environment that lends itself to virtual reality (VR)-based simulations. However, VR has not been previously described for this purpose. Two simulations were developed to test the use of VR in simulating pediatric CICU clinical scenarios, one simulating junctional ectopic tachycardia and low cardiac output syndrome, and the other simulating acute respiratory failure in a patient with suspected coronavirus disease 2019. Six attending pediatric cardiac critical care physicians were recruited to participate in the simulations as a pilot test of VR’s feasibility for educational and practice improvement efforts in this highly specialized clinical environment. All participants successfully navigated the VR environment and met the critical endpoints of the two clinical scenarios. Qualitative feedback was overall positive with some specific critiques regarding limited realism in some mechanical aspects of the simulation. This is the first described use of VR in pediatric cardiac critical care simulation.
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Affiliation(s)
- Bradford H Ralston
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Renee C Willett
- Cardiac Critical Care, Children's National Hospital, Washington, DC, USA.,Division of Cardiac Critical Care, George Washington University, Washington, DC, USA
| | | | - Nina M Brown
- Simulation Center, Children's National Hospital, Washington, DC, USA
| | - Heather Walsh
- Simulation Center, Children's National Hospital, Washington, DC, USA
| | - Ricardo A Muñoz
- Cardiac Critical Care, Children's National Hospital, Washington, DC, USA.,Division of Cardiac Critical Care, George Washington University, Washington, DC, USA
| | - Sylvia Del Castillo
- Cardiac Critical Care, Children's Hospital Los Angeles, Los Angeles, USA.,Critical Care Anesthesiology, Keck School of Medicine at University of Southern California, Los Angeles, USA
| | - Todd P Chang
- Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, USA.,Division of Emergency Medicine, Keck School of Medicine at University of Southern California, Los Angeles, USA
| | - Gregory K Yurasek
- Cardiac Critical Care, Children's National Hospital, Washington, DC, USA.,Division of Cardiac Critical Care, George Washington University, Washington, DC, USA
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