Clinical assessment of cardiac performance in infants and children following cardiac surgery

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• 作者：Jonathan R. Egan (1)
  Marino Festa (2)
  Andrew D. Cole (3)
  Graham R. Nunn (3)
  Jonathan Gillis (1)
  David S. Winlaw (3)
  
• 关键词：Paediatric ; Cardiac output ; Thermodilution
• 刊名：Intensive Care Medicine
• 出版年：2005
• 出版时间：April 2005
• 年：2005
• 卷：31
• 期：4
• 页码：568-573
• 全文大小：221KB
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  19. Egan J, Festa M, Winlaw D, Cole A, Gillis J, Nunn G (2003) Comparison of clinical and invasive assessments of cardiac performance following paediatric cardiac surgery. Pediatr Crit Care Med 4 [Suppl]:A101
  
• 作者单位：Jonathan R. Egan (1)
  Marino Festa (2)
  Andrew D. Cole (3)
  Graham R. Nunn (3)
  Jonathan Gillis (1)
  David S. Winlaw (3)
  
  1. Paediatric Intensive Care Unit, The Children’s Hospital at Westmead, 2145, Westmead, NSW, Australia
  2. Paediatric Intensive Care Unit, Guy’s Hospital, St. Thomas-Street, London, SE1?9RT, UK
  3. Adolph Basser Cardiac Institute, The Children’s Hospital at Westmead, 2145, Westmead, NSW, Australia
  

文摘

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??m? (95% range of agreement ±2.7). Clinical estimates of systemic vascular resistance (weighted κ=0.15) and volume status (weighted κ=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.