Advanced hemodynamic monitoring: feasibility of leveraging non-invasive electrocardiometry in critically ill pediatric patients requiring continuous kidney replacement therapy.

Background: Hemodynamic instability occurs in children receiving continuous kidney replacement therapy (CKRT). Electrocardiometry can help characterize hemodynamics beyond traditional blood pressure (BP) and heart rate (HR). We aimed to assess the feasibility and correlations of hemodynamic measurements obtained using electrocardiometry in children receiving CKRT.

Methods: Prospective single-center observational study of pediatric patients receiving CKRT between 11/2019 and 3/2021. Patients who received extracorporeal membranous oxygenation, ventricular assist device, pacemaker, apheresis, no invasive BP, and COVID-19 were excluded. Electrocardiometry measured cardiac index (CI), HR, stroke volume variability (SVV), stroke volume index (SVI), and systemic vascular resistance index (SVRI) continuously; data were aggregated into 1-h epochs, and correlation coefficients were computed using Spearman's rank test.

Results: Seventeen patients with a median age of 43 months (IQR 13-122). Median weight and fluid overload at CKRT start were 13.9 kg (IQR 8.79-29.80) and 14.4% (IQR 2.4-25.6%) + 171.46 mL/kg (IQR 31.10-307.41), respectively. All measurements obtained via ICON were of high quality and no adverse events were identified. CI had a negative correlation with SVRI (r =  - 0.67) and had a positive correlation with SVI (r = 0.83) and mean arterial pressure (MAP) (r = 0.63). HR did not correlate with any hemodynamic variables, while MAP only correlated with SVI (r = 0.63).

Conclusions: Electrocardiometry can assess the hemodynamic profile of children receiving CKRT. Compensatory cardiovascular changes remain intact in children receiving CKRT, as evidenced by correlations between SVI, SVRI, CI, and MAP. Future studies should investigate how this technology could enable more individualized CKRT prescriptions and improve patient outcomes.