caa a22 4500 605509980 CHVBK 20210128100643.0 cr unu---uuuuu 210128e20150601xx s 000 0 eng 10.1007/s10877-014-9618-y doi (NATIONALLICENCE)springer-10.1007/s10877-014-9618-y Accuracy of the transpulmonary ultrasound dilution method for detection of small anatomic shunts [Elektronische Daten] [R. Saxena, N. Krivitski, K. Peacock, A. Durward, J. Simpson, S. Tibby] The purpose of this study wasto investigate the qualitative and quantitative accuracy of transpulmonary ultrasound dilution (UD) (COstatus™, Transonic Systems) for the detection of small anatomic shunts. It was a prospective, observational study in a multi-disciplinary pediatric intensive care unit. Seventy-three critically ill children (67 post cardiac surgery), with a median (IQR) age of 10 (3-50.3)months and a median (IQR) weight of 8 (3.43-13)kg were enrolled. Ultrasound dilution (UD) measurements were performed on patients within 1h of undergoing two-dimensional echocardiography, which was used as the comparator technique. Shunt was diagnosed by characteristic changes on the UD curve shape, and was considered "test-positive” only if two or more measurements suggested the presence of the shunt. The UD technology also provided an estimate of pulmonaryto systemic blood flow ratio (Qp:Qs). 12/73 (16.4%) patients had a shunt identified by both UD and echocardiography. The overall accuracy (95% CI) was 86.1% (75.6-96.6%), with a sensitivity of 85.7% (57.2-98.2%) and specificity of 86.4% (75.0-94.0%). The estimated Qp:Qs ranged from 0.7 to 1.4, which was consistent qualitatively with the echocardiographic findings on color flowdoppler. Shunt was detected by UD alone in eight children; six of these had clinical conditions known to compromise dilution curve analysis (valve regurgitation, asymmetric pulmonary blood flow). Shunt was detected by echocardiography alone in two children; in both cases the shunt was tiny. UD is an accurate method for the detection of small anatomical shunts, both qualitatively and quantitatively. Springer Science+Business Media New York, 2014 Ultrasound dilution nationallicence Echocardiography nationallicence Shunt detection nationallicence Saxena R. Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut Krivitski N. Transonic Systems Inc, 34 Dutch Mill Road, 14850, Ithaca, NY, USA aut Peacock K. Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut Durward A. Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut Simpson J. Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut Tibby S. Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut Journal of Clinical Monitoring and Computing Springer Netherlands 29/3(2015-06-01), 407-414 1387-1307 29:3<407 2015 29 10877 https://doi.org/10.1007/s10877-014-9618-y text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10877-014-9618-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Saxena R. Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut NATIONALLICENCE 700 1- Krivitski N. Transonic Systems Inc, 34 Dutch Mill Road, 14850, Ithaca, NY, USA aut NATIONALLICENCE 700 1- Peacock K. Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut NATIONALLICENCE 700 1- Durward A. Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut NATIONALLICENCE 700 1- Simpson J. Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut NATIONALLICENCE 700 1- Tibby S. Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK aut NATIONALLICENCE 773 0- Journal of Clinical Monitoring and Computing Springer Netherlands 29/3(2015-06-01), 407-414 1387-1307 29:3<407 2015 29 10877