Clinicians’ abilities to estimate cardiac index in ventilated children and infants

• Published in: Archives of disease in childhood Vol. 77; no. 6; pp. 516 - 518
• Main Authors: Tibby, Shane M, Hatherill, Mark, Marsh, Michael J, Murdoch, Ian A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.12.1997; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Agreements; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood pressure; Body Surface Area; cardiac index; Cardiac Output; Catheters; Child; Child, Preschool; Clinical Competence; Coefficient of variation; Confidence intervals; Correlation; Emergency and intensive care: techniques, logistics; Estimates; Humans; Infant; Intensive care; Intensive care medicine; Intensive Care Units, Pediatric; Measurement Techniques; Medical Evaluation; Medical sciences; Monitoring; Mortality; Nitric oxide; Original; Patients; Physical Examinations; Positive Reinforcement; Pulmonary arteries; Respiration, Artificial; Respiratory distress syndrome; Scientific Concepts; Statistical Analysis; Thermodilution; Variables; Veins & arteries; Ventilation; England; United Kingdom; Great Britain; Europe; Human; Assisted ventilation; Estimation; Cardiac index; Infant; Thermodilution; Laboratory investigations; Vocational aptitude; Clinical investigation; Hemodynamics; Child; Professional evaluation; Comparative study
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.77.6.516

OBJECTIVES To evaluate the ability of clinicians involved in the provision of paediatric intensive care to estimate cardiac index in ventilated children, based on physical examination and clinical and bedside laboratory data. METHODS Clinicians were exposed to all available haemodynamic and laboratory data for each patient, allowed to make a physical examination, and asked to first categorise cardiac index as high, high to normal, low to normal, or low, and then to quantify this further with a numerical estimate. Cardiac index was measured simultaneously by femoral artery thermodilution (coefficient of variation 5.37%). One hundred and twelve estimates were made by 27 clinicians on 36 patients (median age 34.5 months). RESULTS Measured cardiac index ranged from 1.39 to 6.84 l/min/m2. Overall, there was poor correlation categorically (κ statistic 0.09, weighted κ 0.169) and numerically (r = 0.24, 95% confidence interval 0.06 to 0.41 ), although some variation was seen among the various levels of seniority. CONCLUSION Assuming that objective measurement, and hence manipulation, of haemodynamic variables may improve outcome, these findings support the need for a safe, accurate, and repeatable technique for measurement of cardiac index in children who are critically ill.