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779 Blood Pressure and Heart Rate do not Reflect Cardiac Output in Critically ill Children
  1. A Nusmeier1,
  2. PJ Gooskens2,
  3. JG van der Hoeven1,
  4. J Lemson1
  1. 1Intensive Care, Radboud University Nijmegen Medical Center, Nijmegen
  2. 2Technical Medicine, University of Twente, Enschede, The Netherlands

Abstract

Introduction Treatment to support the circulatory state is often based on the interpretation of clinical parameters while advanced hemodynamic monitoring is not always available or applied in children. Cardiac output(CO) measurement using the transpulmonary thermodilution(TPTD) technique is the gold standard in pediatric patients. We studied the predictive value of clinical parameters of (changes in) CO by comparing the blood pressure and heart rate values with intermittent COTPTD measurements.

Methods A retrospective observational study was performed in a heterogenic critically ill pediatric patient population. Doses of inotropics, if administered, was registered to study their influence on trend monitoring. CO was compared with heart rate(HR) and mean arterial blood pressure(MAP) one minute before every CO measurement. The results were analyzed using correlation and linear regression statistics.

Results 216 CO measurements in 20 patients were analyzed. Median age was 1.7 (range 0.3–5.2) years and median body weight 8.8 (range 3.8–18) kg. The median CO was 1.88 (range 0.61–5.64)l/min. The correlation coefficient (Spearman’s rho) between the CO and HR and MAP was –0.08(p<0.24) resp. 0.31(p<0.0001). Linear regression analysis of CO and both HR and MAP and the influence of inotropics on the relation of changes in CO and changes in HR and MAP are shown in table 1.

Conclusions Heart rate and blood pressure are unreliable in predicting cardiac output in critically ill children. The use of inotropics seems to increase the correlation between changes in HR and BP and changes in CO.

Abstract 779 Table 1

Linear regression analysis

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