Intensive Care Medicine

, Volume 29, Issue 11, pp 1889–1894 | Cite as

Accuracy and repeatability of pediatric cardiac output measurement using Doppler: 20-year review of the literature

Review

Abstract

Objective

Review of the accuracy and repeatability of Doppler cardiac output (CO) measurements in children.

Design

Publications in the scientific literature retrieved using a computerized Medline search from 1982–2002 and a manual review of article bibliographies. Studies comparing Doppler flow measurements with thermodilution, Fick, or dye dilution methods in the pediatric critical care setting were identified to assess the bias, precision, and intra- and interobserver repeatability of Doppler CO measurement. Where results were not suitable for comparison and the original measurements available, data were re-analyzed using appropriate statistical methods and presented in comparative tables.

Results

The precision of pediatric Doppler CO measurements compared to thermodilution, dye dilution, or Fick methods is around 30% and repeatability varies from less than 1% to 22%. Bias is generally less than 10% but varies considerably.

Conclusions

The bias, precision, and repeatability from study to study indicate that Doppler CO measurements are acceptably reproducible in children, with best results when used to track changes rather than absolute values, and using the transesophageal approach.

Keywords

Pediatric Doppler Cardiac output Accuracy Reproducibility 

References

  1. 1.
    Tibby SM, Hatherill M, Marsh MJ, Murdoch IA (1997) Clinicians' abilities to estimate cardiac index in ventilated children and infants. Arch Dis Child 77:516–518PubMedGoogle Scholar
  2. 2.
    Richardson JR, Ferguson J, Hiscox J, Rawles J (1998) Non-invasive assessment of cardiac output in children. J Accid Emerg Med 15:304–307PubMedGoogle Scholar
  3. 3.
    Boyd O, Grounds RM, Bennett ED (1993) A randomised clinical trial of the effect if deliberate increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270:2699–2707PubMedGoogle Scholar
  4. 4.
    Shoemaker WC, Kram HB, Appel PL, Fleming AW (1990) The efficacy of central venous and pulmonary artery catheters and therapy based upon them in reducing mortality and morbidity. Arch Surg 125:1332–1338PubMedGoogle Scholar
  5. 5.
    Bishop MH, Shoemaker WC, Appel PL, Meade P, Ordog GJ, Wasserberger J, Wo CJ, Rimle DA, Kram HB, Umali R (1995) Prospective, randomised trial of survivor values of cardiac index, oxygen delivery and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 38:780–787PubMedGoogle Scholar
  6. 6.
    Hayes MA, Timmins AC, Yau EHS, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722PubMedGoogle Scholar
  7. 7.
    Gattitoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333:1025–1032PubMedGoogle Scholar
  8. 8.
    Thompson AE (1997) Pulmonary artery catheterizaton in children. New Horiz 5:244–250PubMedGoogle Scholar
  9. 9.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 8476:307–310Google Scholar
  10. 10.
    Wodey E, Gai V, Carre F, Ecoffey C (2001) Accuracy and limitations of continuous oesophageal aortic blood flow measurement during general anaesthesia for children: comparison with transcutaneous echography-Doppler. Paediatr Anaesth 11:309–317PubMedGoogle Scholar
  11. 11.
    Tibby SM, Hatherill M, Murdoch IA (2000) Use of transesophageal Doppler ultrasonography in ventilated pediatric patients: derivation of cardiac output. Crit Care Med 28:2045–2050Google Scholar
  12. 12.
    Murdoch IA, Marsh MJ, Tibby SM, McLuckie A (1995) Continuous haemodynamic monitoring in children: use of transoesophageal Doppler. Acta Paediatr 84:761–764PubMedGoogle Scholar
  13. 13.
    Mohan UR, Britto J, Habibi P, deMunter C, Nadel S (2002) Noninvasive measurement of cardiac output in critically ill children. Pediatr Cardiol 23:58–61PubMedGoogle Scholar
  14. 14.
    Critchley LAH and Critchley JA (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15:85–91CrossRefPubMedGoogle Scholar
  15. 15.
    Mellander M, Sabel K, Caidahl K, Solymar L, Eriksson B (1987) Doppler determination of cardiac output in infants and children: comparison with simultaneous thermodilution. Pediatr Cardiol 8:241–246PubMedGoogle Scholar
  16. 16.
    Sholler GF, Whight CM, Celermajer JM (1986) Pulsed Doppler echocardiographic assessment, including use of aortic leaflet separation, of cardiac output in children with structural heart disease. Am J Cardiol 57:1195–1197PubMedGoogle Scholar
  17. 17.
    Notterman DA, Castello FV, Steinberg C, Greenwald BM, O'Loughlin JE, Gold JP (1988) A comparison of thermodilution and pulsed Doppler cardiac output measurement in critically ill children. J Pediatr 115:554–560Google Scholar
  18. 18.
    Morrow WR, Murphy DJ, Fisher DJ, Huhta JC, Jefferson LS, O'Brian Smith E (1988) Continuous wave Doppler cardiac output: use in pediatric patients receiving inotropic support. Pediatr Cardiol 9:131–136PubMedGoogle Scholar
  19. 19.
    Tibballs J, Osborne A, Hockmann M (1988) A comparative study of cardiac output measurement by dye dilution and pulsed Doppler ultrasound. Anaesth Intensive Care 16:272–277PubMedGoogle Scholar
  20. 20.
    Wipperman CF, Schranz D, Huth R, Zepp F, Oelert H, Jungst B (1992) Determination of cardiac output by an angle and diameter independent dual beam Doppler in critically ill infants. Br Heart J 67:180–184PubMedGoogle Scholar
  21. 21.
    Rein A, Hsieh K, Elixaon M, Colan S, Lang P, Sanders S, Casteneda A (1986) Cardiac output estimates in the pediatric intensive care unit using a continuous wave Doppler computer: validation and limitations of the technique. Am Heart J 112:97–102PubMedGoogle Scholar
  22. 22.
    Darmon PL, Hillel Z, Mogtader A, Mindich B, Thys D (1994) Cardiac outout by transesophageal echocardiography using continuous wave Doppler across the aortic valve. Anesthesiology 80:796–805PubMedGoogle Scholar
  23. 23.
    Hudson I, Hudson A, Aitchison T, Holland B, Turner T (1990) Reproducibility of measurements of cardiac output in newborn infants by Doppler ultrasound. Arch Dis Child 65:15–19PubMedGoogle Scholar
  24. 24.
    Claflin KS, Alverson DC, Pathak D, Angelus P, Backstrom C, Werner S (1988) Cardiac output determination in the newborn: reproducibility of the pulsed Doppler velocity measurement. J Ultrasound Med 7:311–315PubMedGoogle Scholar
  25. 25.
    Hanseus K, Björkhem G, Lundström NR (1994) Cardiac function in healthy infants and children: Doppler echocardiographic evaluation. Pediatr Cardiol 15:211–218PubMedGoogle Scholar
  26. 26.
    Childs C, Goldring S, Tann W, Hillier VF (1998) Suprasternal Doppler ultrasound for assessment of stroke distance. Arch Dis Child 79:251–255PubMedGoogle Scholar
  27. 27.
    Hirsimaki K, Kerp P, Seppala T, Holstrom K (1993) Mean or maximum velocity using pulsed Doppler ultrasound in determination of Doppler derived cardiac output in the newborn infant. Med Biol Eng Comput 31:58–56PubMedGoogle Scholar
  28. 28.
    Chew MS, Brandberg J, Bjarum S, Baek Jensen K, Sloth E, Ask P, Hasenkam JM, Janerot Sjöberg B (2000) Pediatric cardiac output measurement using surface integration of velocity vectors: an in vivo validation study. Crit Care Med 28:3664–73661PubMedGoogle Scholar
  29. 29.
    Welch E, Duara S, Suguihara C, Bandstra E, Bancalari E (1994) Validation of cardiac output measurements with noninvasive Doppler echocardiography by thermodilution and Fick methods in newborn piglets. Biol Neonate 66:137–145PubMedGoogle Scholar
  30. 30.
    Stevenson J (1999) Incidence of complications in pediatric transesophageal echocardiography: experience in 1650 cases. J Am Soc Echocardiogr 12:527–532PubMedGoogle Scholar
  31. 31.
    Wallace AW, Salahieh A, Lawrence A, Spector K, Owens C, Alonso D (2000) Endotracheal cardiac output monitor Anesthesiology 92:178–189Google Scholar
  32. 32.
    Alverson DC, Eldridge M, Dillon T, Yabek SM, Berman W (1982) Noninvasive pulsed Doppler determination of cardiac output in neonates and children. J Pediatr 101:46–50PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of Anesthesia and Intensive CareLund University HospitalLundSweden
  2. 2.Department of Intensive CareUniversity HospitalGhent Belgium

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