Pressure recording analytical method for measuring cardiac output in critically ill children: a validation study

Area of Science:

• Pediatric Critical Care Medicine
• Cardiovascular Physiology
• Medical Device Validation

Background:

• Cardiac output (CO) monitoring is crucial in critically ill children.
• The Pressure Recording Analytical Method (PRAM) is a novel arterial pulse contour-based CO measurement technique.
• Limited validation data exists for PRAM in pediatric populations, particularly regarding absolute accuracy and tracking CO changes.

Purpose of the Study:

• To compare CO measurements by PRAM against a transpulmonary dilution method in critically ill children.
• To assess both the absolute accuracy and the ability of PRAM to track CO variations.

Main Methods:

• A cohort of 48 mechanically ventilated children with arterial and central venous catheters were studied.
• Simultaneous CO measurements were obtained using PRAM and transpulmonary ultrasound dilution (UD).
• Measurements were repeated before and after interventions aimed at augmenting CO.

Main Results:

• A total of 210 paired measurements were analyzed.
• PRAM demonstrated a mean bias of 0.02 L/min with wide limits of agreement (±2.21 L/min), resulting in a 116% error.
• Concordance for tracking CO changes was poor, with only 37% of measurements within ±30° on a polar plot.

Conclusions:

• There is an unacceptably poor agreement between UD and PRAM for CO measurement in critically ill children.
• The current PRAM algorithm is not recommended for clinical use in this patient population.
• Further research may be needed to refine PRAM algorithms for pediatric application.