OBJECTIVE: To compare clinical assessment of cardiac performance with an invasive method of haemodynamic monitoring. DESIGN AND SETTING: Prospective observational study in a 16-bed tertiary paediatric intensive care unit. PATIENTS AND PARTICIPANTS: Infants and children undergoing cardiopulmonary bypass and surgical repair of congenital heart lesions. INTERVENTIONS: Based on physical examination and routinely available haemodynamic monitoring in the paediatric intensive care unit, medical and nursing staff assessed cardiac index, systemic vascular resistance index and volume status. Clinical assessment was compared with cardiac index, systemic vascular resistance index and global end diastolic volume index, obtained by femoral artery thermodilution. MEASUREMENTS AND RESULTS: A total of 76 clinical estimations of the three parameters were made in 16 infants and children undergoing biventricular repair of congenital heart lesions. Agreement was poor between clinical and invasive methods of determining all three studied parameters of cardiac performance. Cardiac index was significantly underestimated clinically; mean difference was 0.71 l min(-1) m(-2) (95% range of agreement +/-2.7). Clinical estimates of systemic vascular resistance (weighted kappa=0.15) and volume status (weighted kappa=0.04) showed poor levels of agreement with measured values and were overestimated clinically. There was one complication related to a femoral arterial catheter and one device failure. CONCLUSIONS: Routine clinical assessment of parameters of cardiac performance agreed poorly with invasive determinations of these indices. Management decisions based on inaccurate clinical assessments may be detrimental to patients. Invasive haemodynamic monitoring using femoral artery thermodilution warrants cautious further evaluation as there is little agreement with clinical assessment which is presently standard accepted care in this patient population.
OBJECTIVE: To compare clinical assessment of cardiac performance with an invasive method of haemodynamic monitoring. DESIGN AND SETTING: Prospective observational study in a 16-bed tertiary paediatric intensive care unit. PATIENTS AND PARTICIPANTS: Infants and children undergoing cardiopulmonary bypass and surgical repair of congenital heart lesions. INTERVENTIONS: Based on physical examination and routinely available haemodynamic monitoring in the paediatric intensive care unit, medical and nursing staff assessed cardiac index, systemic vascular resistance index and volume status. Clinical assessment was compared with cardiac index, systemic vascular resistance index and global end diastolic volume index, obtained by femoral artery thermodilution. MEASUREMENTS AND RESULTS: A total of 76 clinical estimations of the three parameters were made in 16 infants and children undergoing biventricular repair of congenital heart lesions. Agreement was poor between clinical and invasive methods of determining all three studied parameters of cardiac performance. Cardiac index was significantly underestimated clinically; mean difference was 0.71 l min(-1) m(-2) (95% range of agreement +/-2.7). Clinical estimates of systemic vascular resistance (weighted kappa=0.15) and volume status (weighted kappa=0.04) showed poor levels of agreement with measured values and were overestimated clinically. There was one complication related to a femoral arterial catheter and one device failure. CONCLUSIONS: Routine clinical assessment of parameters of cardiac performance agreed poorly with invasive determinations of these indices. Management decisions based on inaccurate clinical assessments may be detrimental to patients. Invasive haemodynamic monitoring using femoral artery thermodilution warrants cautious further evaluation as there is little agreement with clinical assessment which is presently standard accepted care in this patient population.
Authors: James Dean Sandham; Russell Douglas Hull; Rollin Frederick Brant; Linda Knox; Graham Frederick Pineo; Christopher J Doig; Denny P Laporta; Sidney Viner; Louise Passerini; Hugh Devitt; Ann Kirby; Michael Jacka Journal: N Engl J Med Date: 2003-01-02 Impact factor: 91.245
Authors: Martin Boehne; Florian Schmidt; Lars Witt; Harald Köditz; Michael Sasse; Robert Sümpelmann; Harald Bertram; Armin Wessel; Wilhelm Alexander Osthaus Journal: Pediatr Cardiol Date: 2012-02-14 Impact factor: 1.655
Authors: Andrea Székely; Tamás Breuer; Erzsébet Sápi; Edgár Székely; András Szatmári; Miklós Tóth; Balázs Hauser; János Gál Journal: Pediatr Cardiol Date: 2011-02 Impact factor: 1.655
Authors: Azriel Perel; Bernd Saugel; Jean-Louis Teboul; Manu L N G Malbrain; Francisco Javier Belda; Enrique Fernández-Mondéjar; Mikhail Kirov; Julia Wendon; Roger Lussmann; Marco Maggiorini Journal: J Clin Monit Comput Date: 2015-12-10 Impact factor: 2.502
Authors: Peter Andrews; Elie Azoulay; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Geoffrey Dobb; Jean-Yves Fagon; Herwig Gerlach; Johan Groeneveld; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Jerome Pugin; Michael Pinsky; Peter Radermacher; Christian Richard; Robert Tasker Journal: Intensive Care Med Date: 2006-02-18 Impact factor: 17.440
Authors: Stephan Schubert; Thomas Schmitz; Markus Weiss; Nicole Nagdyman; Michael Huebler; Vladimir Alexi-Meskishvili; Felix Berger; Brigitte Stiller Journal: J Clin Monit Comput Date: 2008-07-30 Impact factor: 2.502
Authors: Walter Knirsch; Oliver Kretschmar; Maren Tomaske; Kathrina Stutz; Nicole Nagdyman; Christian Balmer; Achim Schmitz; Dominique Béttex; Felix Berger; Urs Bauersfeld; Markus Weiss Journal: Intensive Care Med Date: 2008-02-23 Impact factor: 17.440