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      The normal ranges of cardiovascular parameters measured using the ultrasonic cardiac output monitor

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          Abstract

          The ultrasonic cardiac output monitor ( USCOM) is a noninvasive transcutaneous continuous wave Doppler method for assessing hemodynamics. There are no published reference ranges for normal values in adults (aged 18–60 years) for this device. This study aimed to (1) measure cardiovascular indices using USCOM in healthy adults aged 18–60 years; (2) combine these data with those for healthy children (aged 0–12), adolescents (aged 12–18), and the elderly (aged over 60) from our previously published studies in order to present normal ranges for all ages, and (3) establish normal ranges of USCOM‐derived variables according to both weight and age. This was a population‐based cross‐sectional observational study of healthy Chinese subjects aged 0.5–89 years in Hong Kong. USCOM scans were performed on all subjects, to produce measurements including stroke volume, cardiac output, and systemic vascular resistance. Data from previously published studies (children, adolescents, and the elderly) were included. Normal ranges were defined as lying between the 2.5th and 97.5th percentiles. A total of 2218 subjects were studied (mean age = 16.4, range = 0.5–89; 52% male). From previous studies, 1197 children (aged 0–12, 55% male), 590 adolescents (aged 12–18, 49% male), and 77 elderly (aged 60–89, 55% male) were included. New data were collected from 354 adults aged 18–60 (47% male). Normal ranges are presented according to age and weight. We present comprehensive normal ranges for hemodynamic parameters obtained with USCOM in healthy subjects of all ages from infancy to the elderly.

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          Smoothing reference centile curves: the LMS method and penalized likelihood.

          Refence centile curves show the distribution of a measurement as it changes according to some covariate, often age. The LMS method summarizes the changing distribution by three curves representing the median, coefficient of variation and skewness, the latter expressed as a Box-Cox power. Using penalized likelihood the three curves can be fitted as cubic splines by non-linear regression, and the extent of smoothing required can be expressed in terms of smoothing parameters or equivalent degrees of freedom. The method is illustrated with data on triceps skinfold in Gambian girls and women, and body weight in U.S.A. girls.
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            Hemodynamic parameters to guide fluid therapy

            The clinical determination of the intravascular volume can be extremely difficult in critically ill and injured patients as well as those undergoing major surgery. This is problematic because fluid loading is considered the first step in the resuscitation of hemodynamically unstable patients. Yet, multiple studies have demonstrated that only approximately 50% of hemodynamically unstable patients in the intensive care unit and operating room respond to a fluid challenge. Whereas under-resuscitation results in inadequate organ perfusion, accumulating data suggest that over-resuscitation increases the morbidity and mortality of critically ill patients. Cardiac filling pressures, including the central venous pressure and pulmonary artery occlusion pressure, have been traditionally used to guide fluid management. However, studies performed during the past 30 years have demonstrated that cardiac filling pressures are unable to predict fluid responsiveness. During the past decade, a number of dynamic tests of volume responsiveness have been reported. These tests dynamically monitor the change in stroke volume after a maneuver that increases or decreases venous return (preload) and challenges the patients' Frank-Starling curve. These dynamic tests use the change in stroke volume during mechanical ventilation or after a passive leg raising maneuver to assess fluid responsiveness. The stroke volume is measured continuously and in real-time by minimally invasive or noninvasive technologies, including Doppler methods, pulse contour analysis, and bioreactance.
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              Changes in cardiac output with age.

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                Author and article information

                Contributors
                giles@cattermole.org.uk
                Journal
                Physiol Rep
                Physiol Rep
                10.1002/(ISSN)2051-817X
                PHY2
                physreports
                Physiological Reports
                John Wiley and Sons Inc. (Hoboken )
                2051-817X
                21 March 2017
                March 2017
                : 5
                : 6 ( doiID: 10.1002/phy2.2017.5.issue-6 )
                : e13195
                Affiliations
                [ 1 ] Emergency DepartmentCentre Hospitalier Universitaire de Kigali KigaliRwanda
                [ 2 ] Department of MedicineAustin/Northern Health MelbourneAustralia
                [ 3 ] Department of MedicineWestern Health MelbourneAustralia
                [ 4 ] Accident and Emergency DepartmentQueen Elizabeth Hospital Hong Kong SAR
                [ 5 ] Accident and Emergency Medicine Academic Unit Prince of Wales HospitalThe Chinese University of Hong Kong Hong Kong SAR
                [ 6 ] School of MedicineUniversity of Notre Dame Australia Sydney New South WalesAustralia
                [ 7 ] Intensive Care UnitBathurst Base Hospital Bathurst New South WalesAustralia
                [ 8 ] University Hospital of WalesHeath Park Heath CardiffU.K.
                Author notes
                [*] [* ] Correspondence

                Giles N. Cattermole, Emergency Department, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.

                Tel: +250 7 8412 8319

                E‐mail: giles@ 123456cattermole.org.uk

                Author information
                http://orcid.org/0000-0002-8910-2307
                Article
                PHY213195
                10.14814/phy2.13195
                5371563
                28320891
                7c99cce7-4488-4cf4-b837-2d4d327dd446
                © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 October 2016
                : 30 January 2017
                : 14 February 2017
                Page count
                Figures: 2, Tables: 3, Pages: 9, Words: 5739
                Funding
                Funded by: Chinese University of Hong Kong
                Funded by: Hong Kong College of Emergency Medicine
                Funded by: Health Services Research Fund of the Food and Health Bureau of Hong Kong
                Categories
                Cardiovascular Physiology
                Ageing and Degeneration
                Original Research
                Original Research
                Custom metadata
                2.0
                phy213195
                March 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.9 mode:remove_FC converted:29.03.2017

                diagnostic techniques and procedures,doppler,hemodynamics,normal ranges,ultrasonography

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