Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study.

PURPOSE: To determine the feasibility of using the Ultrasound Cardiac Output Monitor (USCOM) as an adjunct during hemodynamic assessments by a pediatric medical emergency team (PMET). METHODS: Pediatric in-patients at McMaster Children's Hospital aged under 18 years requiring urgent PMET consultation, were eligible. Patients with known cardiac outflow valve defects, Pediatric Critical Care Unit in-patients, and those in cardiorespiratory arrest, were excluded. The primary outcome was feasibility, and the ease of USCOM transport and application as assessed by a self-administered user questionnaire. Secondary outcomes included the quality of USCOM measurements, and agreement in clinical versus USCOM-derived assessments. RESULTS: Forty-one patients from 85 eligible PMET consultations were enrolled between March and August 2011. A total of 55 USCOM assessments were performed on 36 of 41 (87.8%) participants. USCOM could not be completed in 5 (12.2%) participants due to patient agitation (n = 4) and emergent care (n = 1). USCOM was reported as easy to transport and apply by 97.4% and 94.7% of respondents respectively, not obstructive to patient care by 94.7%, and yielded timely measurements by 84.2% respondents. USCOM tracings were of good quality in 41 (75.9%) assessments. Agreement between clinical and USCOM-derived hemodynamic assessments by two independent raters was poor (Rater 1: κ = 0.094; Rater 2: κ = 0.146). CONCLUSION: USCOM can be applied by a PMET during urgent hemodynamic assessments in children. While USCOM has been validated in stable children, its role in guiding hemodynamic resuscitation and informing therapeutic goals in a hemodynamically unstable pediatric population requires further investigation.

Life sciences.

NASA: Space life sciences research activities are reviewed for 2003. Many life sciences experiments were lost with the tragic loss of STS-107. Life sciences experiments continue to fly as small payloads to the International Space Station (ISS) via the Russian Progress vehicle. Health-related studies continue with the Martian Radiation Environment Experiment (MARIE) aboard the Odyssey spacecraft, collecting data on the radiation environment in Mars orbit. NASA Ames increased nanotechnology research in all areas, including fundamental biology, bioastronautics, life support systems, and homeland security. Plant research efforts continued at NASA Kennedy, testing candidate crops for ISS. Research included plant growth studies at different light intensities, varying carbon dioxide concentrations, and different growth media. Education and outreach efforts included development of a NASA/USDA program called Space Agriculture in the Classroom. Canada sponsored a project called Tomatosphere, with classrooms across North America exposing seeds to simulated Mars environment for growth studies. NASA's Office of Biological and Physical Research released an updated strategic research plan.^ieng