Clinicians' abilities to estimate cardiac index in ventilated children and infants
Department of Paediatric Intensive Care,
9th Floor, Guy's Tower, Guy's Hospital, St Thomas Street,
London SE1 9RT
Correspondence to: Dr Tibby.
Accepted 8 July 1997
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.
METHODSClinicians 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).
RESULTSMeasured cardiac index ranged from 1.39 to
6.84 l/min/m2. Overall, there was poor correlation
categorically (
statistic 0.09, weighted 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.
CONCLUSIONAssuming 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.
© 1997 by Archives of Disease in Childhood
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