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

  • Neonatal and Pediatric Intensive Care
  • Published:
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Abstract

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 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.

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Acknowledgements

These findings were previously presented at the 4th World Congress of Pediatric Intensive Care, 8–12 June 2003, Boston, USA [19].

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Authors and Affiliations

  1. Paediatric Intensive Care Unit, The Children’s Hospital at Westmead, 2145, Westmead, NSW, Australia

    Jonathan R. Egan & Jonathan Gillis

  2. Paediatric Intensive Care Unit, Guy’s Hospital, St. Thomas’ Street, London, SE1 9RT, UK

    Marino Festa

  3. Adolph Basser Cardiac Institute, The Children’s Hospital at Westmead, 2145, Westmead, NSW, Australia

    Andrew D. Cole, Graham R. Nunn & David S. Winlaw

Authors
  1. Jonathan R. Egan
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  2. Marino Festa
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  3. Andrew D. Cole
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  4. Graham R. Nunn
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  5. Jonathan Gillis
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  6. David S. Winlaw
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Corresponding author

Correspondence to Jonathan R. Egan.

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Egan, J.R., Festa, M., Cole, A.D. et al. Clinical assessment of cardiac performance in infants and children following cardiac surgery. Intensive Care Med 31, 568–573 (2005). https://doi.org/10.1007/s00134-005-2569-5

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  • DOI: https://doi.org/10.1007/s00134-005-2569-5

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