Background and aims Multimodal haemodynamic monitoring has an important role in PICU, because that can aid the intensivist to perform the management of children with acute circulatory failure.

The aim is to improve the interest of haemodynamic management with multimodal parameters to answer to the 3 most commonly asked questions: Complete clinical diagnosis, guide therapeutics, and repeat measures for evaluation.

Methods In this prospective study, between January 2012 and April 2014, the assessment of haemodynamic was obtained progressively by NIBP, TTE, and estimated continuous cardiac output (esCCO), and/or Oesophageal Doppler, an/or pleth variability index (PVI) for each patient with ACF.

Results On a total of 33 patients with ACF, all patients was treated:

- Volume expansion in 31 patients « fluid responsiveness based on the respiratory variation aortic flow peak velocity Δ Vpeak ao, SV, and inferior vena cava, and/or PVI, FTc, Δ Vpeak by OD .

• 29 responder (Δ SV ≥ 10% by TTE, esCCO and/or OD).

• 2 non responder (Δ SV < 10%).

- Norepinephrine was introduced in 14 patients (objective MAP and or PPC for SPTBI), 2 of them had a profound vasoplegia « DAP < 40 mmHg.

- Dobutamine was introduced in 2 patients with LVEF < 45% (TTE).

Conclusion MHM allows optimisation of systemic haemodynamic: assessment of CO, blood volume status, vascular resistance and contractility.