Noninvasive cardiac output monitoring in the pediatric cardiac Intensive Care Unit.

PURPOSE OF REVIEW: The present article explores some of the newer noninvasive techniques for monitoring cardiac output in the pediatric population. These new techniques can be utilized in both a wide variety of patient sizes and the unique pathology of congenital cardiopathy. These techniques may assist in optimizing therapy in the intensive care setting. RECENT
FINDINGS: Recently, Hoffman et al. found that near-infrared spectroscopy positively correlates with SvO2. Esophageal Doppler is an accurate method only if used by experienced personnel. Both impedance cardiography and electrical cardiometry use thoracic electrical bioimpedance. However, the algorithm differs between the two methods. Cardiometry may be more accurate in patients with a low cardiac output state. Calamandrei et al. found that an analytical method using arterial pulse pressure recording (pressure recording analytical method) shows a high correlation with Doppler echocardiography. Finally, a method like partial CO2 rebreathing was studied by Levy et al., who suggested that this method may be used to trend cardiac output continuously, but not for providing absolute values.
SUMMARY: Although promising, studies validating the use of these methods in a variety of real clinical situations are needed before they will be widely used in pediatric practice.The currently available data suggest that pressure recording analytical method and electrical cardiometry will prove to be useful in the pediatric cardiac ICU to monitor trends in cardiac output.