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Clinicians' abilities to estimate cardiac index in ventilated children and infants
S M Tibby1, M Hatherill, M J Marsh
1Department of Paediatric Intensive Care, Guy's Hospital, London.
Insights
Clinicians showed poor ability to estimate cardiac index in critically ill children using clinical data. Accurate cardiac index measurement is crucial for improving outcomes in pediatric intensive care.
Area of Science:
- Pediatric Intensive Care Medicine
- Hemodynamics
- Clinical Assessment
Background:
- Accurate assessment of cardiac index is vital for managing critically ill children.
- Current methods rely on clinical judgment, which may be subjective.
Purpose of the Study:
- To evaluate the accuracy of clinicians' estimations of cardiac index in ventilated pediatric patients.
- To assess the correlation between clinical judgment and measured cardiac index.
Main Methods:
- Clinicians reviewed patient data and performed physical exams to estimate cardiac index.
- Cardiac index was measured using femoral artery thermodilution.
- 112 estimates were made by 27 clinicians across 36 patients.
Main Results:
- A poor correlation was found between clinicians' categorical and numerical estimates and measured cardiac index.
- The kappa statistic for categorical correlation was 0.09.
- Numerical correlation (r=0.24) was also poor, indicating limited accuracy.
Conclusions:
- Clinicians' ability to estimate cardiac index in critically ill children is limited.
- There is a need for a safe, accurate, and repeatable method for cardiac index measurement in this population.
- Objective hemodynamic monitoring may improve patient outcomes.
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.
Methods:
Clinicians were exposed to all available haemodynamic and laboratory data for each patient, allowed to make a physical examination, and asked to first categorize 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).
Results:
Measured cardiac index ranged from 1.39 to 6.84 1/min/m2. Overall, there was poor correlation categorically (kappa statistic 0.09, weighted kappa 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.
Conclusion:
Assuming 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.