Comparison of cardiac output and cardiac index values measured by critical care echocardiography with the values measured by pulse index continuous cardiac output (PiCCO) in the pediatric intensive care unit:a preliminary study

Abstract

Background: Planning optimal fluid and inotrope-vasopressor-inodilator therapy is essential in critically ill children. Pulse index Contour Cardiac Output (PiCCO) monitoring is an invasive, hemodynamic monitor that provides parameter measurements such as cardiac output (CO), cardiac index (CI). Use of ultrasonography and critical care echocardiography by the pediatric intensivists has increased in recent years. In the hands of an experienced pediatric intensivist, critical echocardiography can accurately measure both CO and CI. Our objective in this study is to compare the CO and CI values measured by pediatric intensivist using critical care echocardiography to the values measured by PiCCO monitor in critically ill pediatric patients. Methods: A prospective observational study from a tertiary university hospital PICU. A total of 15 patients who required advanced hemodynamic monitoring and applied PiCCO monitoring were included the study. The diagnosis of patients were septic shock, cardiogenic shock, acute respiratory distress syndrome, pulmonary edema. Forty nine echocardiographic measurements were performed and from 15 patients. All echocardiographic measurements were performed by a pediatric intensive care fellow experienced in cardiac ultrasound. The distance of left ventricle outflow tract (LVOT) in the parasternal long axis and LVOT-Velocity Time Integral (LVOT-VTI) measurement was performed in the apical five chamber image. Cardiac output_echocardiography (CO_echo) and CI_echocardiography (CI_echo) were calculated using these two measurements. PiCCO (PiCCO, Pulsion Medical Systems, Munich, Germany) monitoring was performed. Cardiac output (CO_picco) and CI (CI_picco) were simultaneously measured by PiCCO monitor and echocardiography. We performed a correlation analysis with this 49 echocardiographic measurements and PiCCO measurements.

Effect of focused cardiopulmonary ultrasonography on clinical outcome of septic shock: a randomized study

“…A previous study indicated a strong positive correlation (p < 0.001, r = 0.985) between the cardiac output values measured by critical care echocardiography and PiCCO in pediatric patients. 33 In the present study, however, one main purpose for the use of ultrasonography for treatment guidance in the ICU was to reduce the need for invasive procedures. Therefore, PiCCO was not considered a routine monitoring item.…”

Application and Nursing of Pulse Index Continuous Cardiac Output (PiCCO) Volume Monitoring in Early Fluid Resuscitation in Patients with Septic Shock

“…Further, another recent study showed that echocardiography measurements of CO and CI were comparable to PiCCO measurements, which was non-invasive compared with PiCCO. This result indicated the limitation of PiCCO, and thus echocardiography measurement could be used to guide fluid and vasoactive-inotropic management of critically ill pediatric patients [14]. From Table 3, it was found that the observation group patients effectively shortened the length of stay in the ICU and reduced the mortality rate.…”

A trend skill that makes pediatric intensivists stand out: Critical care echocardiography

“…The management of the optimal fluid and inotropic-vasopressor-inodilator therapy in severely ill pediatric patients should be planned by calculating cardiac output while conducting fluid therapy and inotrope treatment in children with shock, 19 Correspondence to email nagehan_aslan@hotmail.com doi: 10.1002/ajum.12233 especially in shock conditions which result in high mortality and morbidity in severely ill children. 20 The rate of CCE use in cardiac output assessments was 31% in Turkey PICUs. 6 The latest two septic shock guidelines stressed the significance of the cardiac index calculations in treatment plans.…”

“…25 We have demonstrated that cardiac index measurements by CCE compare favourably with PiCCO measurements and may be as important as invasive PiCCO-monitoring measurements in the planning of the vasopressor-inotrope and fluid treatment for the severely ill pediatric patients. 20…”