Cardiac output and systemic vascular resistance: Clinical assessment compared with a noninvasive objective...

Area of Science:

• Pediatric Intensive Care Medicine
• Hemodynamic Monitoring
• Critical Care Research

Background:

• Accurate assessment of cardiac output (CO) and systemic vascular resistance (SVR) is crucial for managing patients in shock.
• Physician clinical assessment is commonly used, but its accuracy and consistency can be variable.
• The ultrasonic cardiac output monitor (USCOM) offers an objective method for hemodynamic assessment.

Purpose of the Study:

• To compare physician assessments of CO and SVR with measurements obtained from the USCOM in pediatric shock patients.
• To investigate how the availability of USCOM data might influence physician therapeutic decisions.

Main Methods:

• A prospective, observational study was conducted in a pediatric intensive care unit involving 40 children with shock.
• Physicians clinically assessed CO and SVR, categorizing them as high, normal, or low.
• An investigator simultaneously measured cardiac index (CI) and systemic vascular resistance index (SVRI) using USCOM and categorized these values.

Main Results:

• Overall agreement between physician assessments and USCOM measurements for CI and SVRI was poor (κ = 0.18 and κ = 0.16, respectively).
• Interobserver agreement among physicians for both CI and SVRI was also poor (κ = 0.33 and κ = 0.28, respectively).
• A significant proportion (21%) of theoretical physician interventions were deemed 'unacceptable' based on USCOM measurements.

Conclusions:

• There is a substantial lack of agreement between physician-based hemodynamic assessments and objective USCOM data in pediatric shock.
• Significant interobserver variability exists among physicians in assessing CI and SVRI.
• Objective hemodynamic monitoring with tools like USCOM may be necessary to reduce variability and enhance diagnostic accuracy in shock management.