Femoral Arterial Thermodilution Research Articles

Comparison between pressure-recording analytical method (PRAM) and femoral arterial thermodilution method (FATD) cardiac output monitoring in an infant animal model of cardiac arrest.

BackgroundThe pressure-recording analytical method is a new semi-invasive method for cardiac output measurement (PRAM). There are no studies comparing this technique with femoral artery thermodilution (FATD) in an infant animal model.MethodsA prospective study was performed using 25 immature Maryland pigs weighing 9.5 kg. Fifty-eight simultaneous measurements of cardiac index (CI) were made by FATD and PRAM at baseline and after return of spontaneous circulation. Differences, correlation, and concordance between both methods were analyzed. The ability of PRAM to track changes in CI was explored with a polar plot.ResultsMean CI measurements were 4.5 L/min/m2 (95 % CI, 4.2–4.8 L/min/m2; coefficient of variation, 27 %) by FATD and 4.0 L/min/m2 (95 % CI, 3.6–4.3 L/min/m2; coefficient for variation, 37 %) by PRAM (difference, 0.5 L/min/m2; 95 % CI for the difference, 0.1–1.0 L/min/m2; p = 0.003; n = 58). No correlation between both methods was observed (r = 0.170, p = 0.20). Limits of agreement were −2.9 to 4.0 L/min/m2 (−69.9 to 84.9 %). Percentage error was 80.6 %. Only 26.1 % of data points lied within an absolute deviation of ±30° from the polar axis.ConclusionsNo correlation nor concordance between both methods was observed. Limits of agreement and percentage of error were high and clinically not acceptable. No concurrence between both methods in CI changes was observed. PRAM is not a useful method for measurement of the CI in this pediatric model of cardiac arrest.

Agreement in hemodynamic monitoring during orthotopic liver transplantation: a comparison of FloTrac/Vigileo at two monitoring sites with pulmonary artery catheter thermodilution.

To study agreement in cardiac index (CI), systemic vascular resistance index (Systemic VRI) and stroke volume variation (SV variation) between the FloTrac/Vigileo at radial and femoral arterial cannulation sites, and pulmonary artery catheter (PAC) thermodilution, in patients undergoing orthotopic liver transplantation. A prospective observational study of 25 adult patients with liver failure. Radial and femoral arteries were cannulated with standardised FloTrac/Vigileo arterial transducer kits and a PAC was inserted. CI, SV variation and Systemic VRI were measured four times (30min after induction of anesthesia, 30min after portal vein clamping, 30min after graft reperfusion, 30min after commencement of bile duct anastomosis). The bias, precision, limits of agreement (LOA) and percentage errors were calculated using Bland-Altman statistics to compare measurements from radial and femoral arterial cannulation sites and PAC thermodilution. Neither radial nor femoral CI achieved acceptable agreement with PAC CI [radial to PAC bias (SD) 1.17 (1.49)L/min/m2, percentage error 64.40%], [femoral to PAC bias (SD) -0.71 (1.81)L/min/m2, percentage error 74.20%]. Agreement between radial and femoral sites for CI [mean difference (SD) -0.43 (1.51)L/min/m2, percentage error 70.40%] and Systemic VRI [mean difference (SD) 0.03 (4.17) LOA ±8.17mmHgminm2/L] were also unacceptable. Agreement in SV variation between radial and femoral measurement sites approached a clinically acceptable threshold [mean difference (SD) 0.68 (2.44)%), LOA ±4.78%]. FloTrac/Vigileo CI cannot substitute for PAC thermodilution CI, regardless of measurement site. SV variation measurements may be interchangeable between radial and femoral sites for determining fluid responsiveness.

Comparison of pulmonary artery and transpulmonary thermodilution cardiac output measurements in unsedated newborn calves

ObjectiveTo compare the agreement, repeatability and trending ability of transpulmonary thermodilution (TPTD) and pulmonary artery thermodilution (PATD) cardiac output ( Q˙t) measurements in unsedated newborn calves. Study designProspective experimental trial. AnimalsEight newborn calves weighing a median (range) of 53 (46–59) kg. MethodsPulmonary and femoral artery thermodilution catheters were placed under local anaesthesia. A total of 382 PATD and TPTD Q˙t measurements were performed simultaneously. Cardiac output was influenced by intravenous doxapram and theophylline in a randomized crossover fashion. Bland–Altman analysis for multiple comparisons, concordance and polar plots were used to assess TPTD against PATD. ResultsMedian (range) cardiac index values measured with PATD and TPTD were 197 mL kg−1 minute−1 (74–335 mL kg−1 minute−1) and 196 mL kg−1 minute−1 (59–395 mL kg−1 minute−1), respec-tively. A small mean bias of -3 mL kg−1 minute−1 with limits of agreement (LOA) of -64 to 58 mL kg−1 minute−1 and a percentage error of 31% were found. Eighty-two mean values were calculated. This reduced the LOA to -50 to 41 mL kg−1 minute−1 with a similar small bias and a percentage error of 23%. Mean TPTD tracked changes in Q˙t compared with mean PATD with 90% concordance, a mean polar angle of 6° and radial LOA of 43°, indicating marginal trending ability. Keeping the femoral artery catheter patent and obtaining acceptable measurements were very challenging because the calves were not used to being restrained. Calf movement had less influence on PATD. Conclusions and clinical relevanceWe recommend that PATD remains the reference method to measure Q˙t in unsedated newborn calves. However, the robust results of the evaluation of the less invasive TPTD technique warrants further evaluation taking into account the difficulties reported in this study.

Cardiac index monitoring by femoral arterial thermodilution after cardiac surgery in children

PurposeThe aim of this study is to determine whether the maintenance of cardiac index (CI) measured by femoral arterial thermodilution during the postoperative period after heart surgery in children is related to short-term outcome. Materials and MethodsA prospective observational study in a pediatric intensive care unit at a referral hospital for congenital heart disease was conducted. Thirty-five children after open heart surgery were monitored in 5 planned times with PiCCO (Pulsion Medical System AG, Munich, Germany) during the first 24 hours after admission. Normal CI was defined as 3 L min−1 m−2 or greater. ResultsEighteen patients hold CI at every measurement point. In this group, the median stay in the pediatric intensive care unit was 3 days (range, 2-7 days) compared with the median of 6 days (range, 2-34 days) obtained by the rest (P < .005). Duration of mechanical ventilation was 12 hours (range, 3-48 hours), and overall stay in the hospital was 6 days (range, 2-15 days) compared with 25 hours (range 6-432 hours) and 16 days (range, 4-50 days) obtained by the second group (P < .05). No complications were attributed to the use of the device. ConclusionsMonitoring by femoral arterial thermodilution has been feasible in our experience. Maintenance of a CI of 3 L min−1 m−2 or greater is related to a better patient's early outcome.

792 Predictors of Fluid Response in a Animal Model of Hemorrhagic Shock

Background and AimsPrediction of fluid response is of paramount importance when managing shock. The aim of the present study was to test the hypothesis that pre-infusion values of several hemodynamic...

Pulmonary arterial thermodilution, femoral arterial thermodilution and bioreactance cardiac output monitoring in a pediatric hemorrhagic hypovolemic shock model

AimBioreactance is a new non-invasive method for cardiac output measurement (NICOM). There are no studies that have analysed the utility of this technique in a pediatric animal model of hemorrhagic shock. MethodsA prospective study was performed using 9 immature Maryland pigs weighing 9 to 12kg was performed. A Swan-Ganz catheter, a PiCCO catheter and 4 dual surface electrodes were placed at the four corners of the anterior thoracic body surface. Shock was induced by withdrawing a blood volume of 30mL/kg, and then after, 30mL/kg of Normal saline was administered. Seven simultaneous measurements of cardiac index (CI) were made by pulmonary artery thermodilution (PATD), Femoral artery thermodilution (FATD), and NICOM before, during, and after hypovolaemia and during and after volume expansion. ResultsThe mean difference (bias) of differences (limits of agreement) between PATD and FATD was 0.84 (−1.87–3.51)L/min/1.77m2, between PATD and NICOM was 1.95 (−1.79–5.69)L/min/1.77m2, and between FATD and NICOM was 1.06 (−1.40–3.52)L/min/1.77m2. A moderate correlation was found between PATD and FATD (r=0.43; P=0.01), but no correlation was found between bioreactance and either PATD or FATD. Hypovolemia and volume expansion produced important significant differences in CI as measured by PATD and FATD, while the changes with bioreactance were small and non significant. ConclusionsPATD and FATD measurements showed similar responses to hypovolemic shock and volume expansion. Bioreactance persistently underestimates the CI and is not significantly altered by either inducing hemorrhagic shock, or later, through volume expansion. Bioreactance is not a suitable method for monitoring the CI in pediatric hemorrhagic shock.

PiCCO (Pulse Contour Cardiac Output) catheter: The new gold standard for monitoring core temperature during mild hypothermia?

Purpose of the study: Mild hypothermia after cardiac arrest improves neurologic outcome. The temperature site best reflecting core temperature is considered to be the pulmonary artery, yet it is limited by invasiveness. In recent years a femoral arterial thermodilution catheter (PiCCO—Pulse Contour Cardiac Output) has been introduced in clinical practice as a safe and accurate hemodynamic monitoring system, which is able to measure blood temperature.

Cardiac output and blood volume parameters using femoral arterial thermodilution

The pulse-induced continuous cardiac output (PiCCO) system is a less invasive method than pulmonary thermodilution for the measurement of cardiac output and estimating blood volume parameters. The normal values in children have not been defined. The purpose of the present paper was therefore to evaluate cardiac output and parameters of blood volume using femoral arterial thermodilution in critically ill children. A prospective study was performed in 17 critically ill children aged between 2 months and 14 years. Two measurements were taken for each determination of cardiac output, global end diastolic volume (GEDVI), intrathoracic blood volume index (ITBI), extravascular lung water index (ELWI), systolic volume index (SVI), stroke volume variation (SVV), cardiac function index (CFI), left ventricular contractility (dp/dt max), and the systemic vascular resistance index (SVRI). One hundred and seventeen measurements were performed. The mean cardiac index (CI) was 3.5 +/- 1.3 L/min per m(2). The GEDVI (399.7 +/- 349.1 mL/m(2)), ITBI (574.5 +/- 212.2 mL/m(2)) and dp/dt max (804.6 +/- 372.1 mmHg/s) were lower than reported in adults, whereas ELWI (18.9 +/- 9.3 mL/m2) and CFI (8 +/- 2.5 L/min) where higher. The GEDVI, SVI, dp/dt max and CI increased with the weight of the patients whereas the ELWI values decreased. Femoral arterial thermodilution is a suitable technique for the measurement of cardiac output in critically ill children. The intrathoracic and intracardiac volumes are lower than in adults, whereas extrapulmonary water is higher; these values are related to the weight of the patient.

Estimation of the parameters of cardiac function and of blood volume by arterial thermodilution in an infant animal model

Experimental studies in adults and in animals have reported that estimation of the intracardiac volumes by arterial thermodilution is a more reliable method of blood volume estimation than pressure measurement. The objective of this study has been to analyze the values of cardiac function and blood volume in an infant animal model using the arterial thermodilution technique. A total of 202 measurements of cardiac output were performed by femoral arterial thermodilution in 38 Maryland piglets weighing between 8 and 16 kg, to determine the normal values of blood volume obtained by arterial thermodilution (PiCCO method) in an infant animal model. The following parameters were measured: blood volume [global end-diastolic volume index (GEDVI), total intrathoracic blood index (ITBI), extravascular lung water index (ELWI), systolic volume index (SVI)] and parameters of cardiac and vascular function [systolic volume index (SVI), cardiac function index (CFI), left ventricular contractility (Dp/dtmax), and systemic vascular resistance index) (SVRI)]. The cardiac index, 4.3 +/- 1.2 l x min(-1) x m(2), was within the normal range. The GEDVI, 198 +/- 48.6 ml x m(2), and ITBI, 574.1 +/- 113.4 ml x m(2), were lower than the normal values reported in adults, whereas the ELWI, 16.3 +/- 5.2 ml x kg(-1), was higher. Intrathoracic and intracardiac volume values obtained by arterial thermodilution are lower than those considered normal in the adult, whereas the extravascular lung water is higher. These values must be taken into account when the PiCCO method is used in small children.

Correlation between Cardiac Output Measured by the Femoral Arterial Thermodilution Technique Pulmonary Arterial and that Measured by Contour Pulse Analysis in a paediatric animal model

To evaluate the correlation between two methods for the determination of cardiac output: the femoral arterial thermodilution technique (FATD) and the arterial pulse contour analysis (PCCO) using the PiCCO catheter. We performed a prospective animal study using 51 immature Maryland pigs weighing 9 to 16 kg. A 4- or 5-Fr arterial PiCCO catheter was introduced into the femoral artery. In each animal, we made measurements of cardiac output at 30-minute intervals by femoral arterial thermodilution for a total of 209 measurements. We registered the previous PCCO and compared with the mean of two measures of FATD cardiac output. Mean FATD was 1.73 +/- 0.60 L/min and mean PCCO was 1.78 +/- 0.70 L/min (no significant difference). The mean difference (bias) of differences (limits of agreement) was 0.04. The correlation founded between the two methods was 0.786 (95% confidence interval, 0.71-0.83). Femoral arterial thermodilution cardiac output measurements correlates well with pulse contour analysis cardiac output in this paediatric animal model.

Effects of Initiation of Continuous Renal Replacement Therapy on Hemodynamics in a Pediatric Animal Model

There are no studies analyzing the initial hemodynamic impact of continuous renal replacement therapy (CRRT) in children. We have performed a prospective observational study in 34 immature Maryland pigs to analyze the initial hemodynamic changes during venovenous CRRT. The heart rate, blood pressure, central venous pressure (CVP), pulmonary arterial occlusion pressure (PAOP), pulmonary capillary wedge pressure, temperature, and cardiac output (CO), simultaneously by pulmonary arterial thermodilution and femoral arterial thermodilution, were measured at 30-min intervals during 2 h. Venovenous CRRT induced an initial significant diminution of volemic hemodynamic parameters (intrathoracic blood volume, global end-diastolic volume, stroke volume index, PAOP, and CVP). Simultaneously, a significant increase in systemic vascular resistance index and left ventricular contractility, and a decrease in CO, was observed. We conclude that CRRT in a pediatric animal model induces initial hypovolemia, and a systemic cardiovascular response with vasoconstriction and increase in ventricular contractility.

HDAF porcine cardiac xenograft maintains cardiac output after orthotopic transplantation into baboon – a perioperative study

Only limited data are available on the physiological functional compatibility of cardiac xenografts after orthotopic pig to baboon transplantation (oXHTx). Thus we investigated hemodynamic parameters including cardiac output (CO) before and after oXHTx. Orthotopic xenogeneic heart transplantation from nine hDAF transgeneic piglets to baboons was performed. We used femoral arterial thermodilution for the invasive assessment of CO and stroke volume. Baseline CO of the baboons after induction of anesthesia was 1.36 (1.0-1.9) l/min. 30 to 60 min after termination of the cardiopulmonary bypass, CO of the cardiac xenograft was significantly increased to 1.72 (1.3-2.1) l/min (P < 0.01). The stroke volumes of the baboon heart before transplantation and the cardiac xenograft was comparable [14.9 (11-26) vs. 11.8 (10-23) ml]. Thus the higher CO was achieved by an increase in heart rate after oXHTx [75.0 (69-110) vs. 140.0 (77-180)/min; P < 0.01]. Despite the increased CO, oxygen delivery was reduced [256 (251-354) vs. 227 (172-477) ml/min; P < 0.01] due to the inevitable hemodilution during the cardiopulmonary bypass and the blood loss caused by the surgical procedures. Our results demonstrate that in the early phase after orthotopic transplantation of hDAF pig hearts to baboons, cardiac function of the donor heart is maintained and exceeds baseline CO. However, in the early intraoperative phase this was only possible by using inotropic substances and vasopressors due to the inevitable blood loss and dilution by the priming of the bypass circuit.

Clinical assessment of cardiac performance in infants and children following cardiac surgery

To compare clinical assessment of cardiac performance with an invasive method of haemodynamic monitoring. Prospective observational study in a 16-bed tertiary paediatric intensive care unit. Infants and children undergoing cardiopulmonary bypass and surgical repair of congenital heart lesions. Based on physical examination and routinely available haemodynamic monitoring in the paediatric intensive care unit, medical and nursing staff assessed cardiac index, systemic vascular resistance index and volume status. Clinical assessment was compared with cardiac index, systemic vascular resistance index and global end diastolic volume index, obtained by femoral artery thermodilution. A total of 76 clinical estimations of the three parameters were made in 16 infants and children undergoing biventricular repair of congenital heart lesions. Agreement was poor between clinical and invasive methods of determining all three studied parameters of cardiac performance. Cardiac index was significantly underestimated clinically; mean difference was 0.71 l min(-1) m(-2) (95% range of agreement +/-2.7). Clinical estimates of systemic vascular resistance (weighted kappa=0.15) and volume status (weighted kappa=0.04) showed poor levels of agreement with measured values and were overestimated clinically. There was one complication related to a femoral arterial catheter and one device failure. Routine clinical assessment of parameters of cardiac performance agreed poorly with invasive determinations of these indices. Management decisions based on inaccurate clinical assessments may be detrimental to patients. Invasive haemodynamic monitoring using femoral artery thermodilution warrants cautious further evaluation as there is little agreement with clinical assessment which is presently standard accepted care in this patient population.

Effects of Sildenafil on Cardiac Sympathetic Activity in Patients with Chronic Heart Failure

Purpose: Sildenafil has been reported to increase sympathetic outflow in normal volunteers. To date, experience with sildenafil in patients with congestive heart failure (CHF) is limited and the impact of phosphodiesterase V inhibition on sympathetic activity in this population has not been evaluated. Methods: Eight patients with CHF secondary to dilated cardiomyopathy were studied. They were instrumented with pulmonary artery, femoral artery, and coronary sinus thermodilution catheters. Cardiac sympathetic activity was measured by the cardiac norepinephrine spillover (CANESP) technique. Hemodynamics and CANESP were determined at baseline and in response to a steady state infusion of sildenafil. Results: The mean age was 59±6 yr and their EF was 24±4%. Sildenafil was given as bolus of 2.6±0.1mg followed by an infusion of 0.8±0.1mg over 20 minutes. Sildenafil caused a significant reduction in right atrial (6±1 vs. 3±1 mmHg, P<0.006), mean pulmonary artery (29±4 vs. 20±3 mmHg, P<0.002), and mean arterial pressures (75±2 vs. 69±1 mmHg, P<0.008). Heart rate and cardiac output did not change. Despite the fall in arterial pressure the infusion of sildenafil was associated with a significant reduction in CANESP (305±36 vs. 235±37 pmol/min, P<0.02). Conclusion: Sildenafil infusion was associated with a significant reduction in cardiac sympathetic activity. These data confirm that the acute administration Sildenafil has modest, beneficial hemodynamic effects in patients with CHF and is not associated with an increase in sympathetic activity directed toward the heart muscle.

Comparison of pulmonary arterial thermodilution and arterial pulse contour analysis: evaluation of a new algorithm

Study Objective: To compare cardiac index (CI) measurement by arterial pulse contour analysis using two different algorithms (CI PC , CI PCnew ) with pulmonary arterial thermodilution values (CI PA ) so as to evaluate the difference between the conventional algorithm, CI PC , and a new algorithm, CI PCnew , that accounts for patients’ individual aortic compliance. Design: Prospective, clinical study. Setting: Intensive care unit of a university hospital. Patients: 20 ASA physical status II and III patients following elective cardiac surgery. Measurements and Main Results: 360 parallel triplicate determinations of CI (CI PA , CI PC , CI PCnew ) were performed within a 90-minute period during the immediate postoperative period. Prior to the start of the study period, CI PC as well as CI PCnew were calibrated by triplicate femoral arterial thermodilution measurements. Regression analysis of CI PA and CI PC , as well as CI PA and CI PCnew , revealed r = 0.89, p < 0.001, and r = 0.93, p < 0.001, respectively. Bland-Altman analysis was used for determining the accuracy and precision of CI PC and CI PCnew compared with CI PA . The mean differences (m) and standard deviation (SD) between CI PA and CI PC, as well as CI PA and CI PCnew , resulted in m = − 0.312 L/min/m 2 , SD = 0.456 L/min/m 2 , and m = − 0.140 L/min/m 2 , SD = 0.328 L/min/m 2 , respectively. Conclusion: Arterial pulse contour analysis measurement of CI using either algorithm correlates well with CI values derived by pulmonary arterial thermodilution. However, the algorithm introduced in this study proved to be a more accurate predictor of values as derived by pulmonary artery catheter.

Are transoesophageal Doppler parameters a reliable guide to paediatric haemodynamic status and fluid management?

Transoesophageal Doppler (TOD) has been used in adults to optimise left ventricular filling on the basis of the waveform parameters. We wished to see if a similar relationship exists in children, specifically: (a) whether change in thermodilution stroke volume (SV) following a fluid bolus corresponded to change in Doppler stroke distance, Doppler corrected flow time (FTc), or central venous pressure (CVP); (b) whether a response to fluid challenge (defined as an increase in SV of greater than 10%) can be predicted on the basis of an absolute value for FTc or CVP prior to fluid bolus; and (c) the relationship between FTc and systemic vascular resistance index. Prospective, comparison study. Sixteen-bed paediatric intensive care unit of a university hospital. Ninety-four ventilated children were studied, median (range) age 25 months (4 days- 16 years). Diagnoses included: post-cardiac surgery (n = 58), sepsis/multi-organ failure (n = 29), respiratory disease (n = 5), and other (n = 2). A 4-MHz, 5.5-mm diameter, flexible TOD probe was placed when patients were haemodynamically stable. Five consecutive measurements of stroke distance and FTc were made and averaged, concurrently with five SV measurements by femoral artery thermodilution. SV was then augmented by administration of fluid (10 ml/kg), and haemodynamic recordings were repeated. The median (range) SV was 17 ml (2-64 ml). The median coefficients of variation were 3.9 % for SV, 3.5 % for stroke distance, and 3.1% for FTc. Changes in SV were accurately tracked by changes in stroke distance (mean bias 1.8 %, limits of agreement +/- 17%), but not by FTc or CVP. FTc was weakly inversely correlated with systemic vascular resistance (r = -0.15, P < 0.05). Among non-cardiac patients (n = 36), the optimal FTc that predicted an improvement in SV following fluid bolus was 0.394 s (area under ROC curve 0.756), giving a sensitivity of 90 %, specificity of 62 %, positive predictive value of 47 %, and a negative predictive value of 94 %. CVP was a poor predictor for all patient groups. TOD stroke distance is able to follow changes in SV following fluid bolus amongst ventilated children, and can predict when further volume loading is unlikely to improve SV amongst general, but not cardiac ICU patients. CVP is a poor discriminator of volume status in this group of patients.

Less invasive, continuous hemodynamic monitoring during minimally invasive coronary surgery

Background. Minimally invasive coronary surgery has gained more and more clinical acceptance. A clear contrast to the minimally invasive idea is the highly invasive pulmonary artery catheter used for hemodynamic monitoring during the operation. We evaluated a less invasive device which calculates cardiac output (CO) and hemodynamics based on arterial pulse-contour analysis. Methods. In 20 patients revascularized by the off-pump technique with the octopus system, agreement of CO by pulse-contour was compared to pulmonary arterial and femoral arterial thermodilution and hemodynamic alterations during the operation were recorded. Pulse-contour CO is computed by measuring the area under the arterial pressure waveform and dividing it by aortic impedance. Aortic impedance is determined by an arterial thermodilution at the onset of the system. Results. Correlation of pulmonary arterial and arterial thermodilution CO to pulse-contour CO was 0.91 and 0.90 respectively (both p < 0.01). Coefficients of variations were 6.2% and 6.7%. The bias was 0.1 L per minute and standard deviations were 0.42 L per minute and 0.55 L per minute. Hemodynamic changes during the operations were seen mainly during the distal anastomosis of the first diagonal branch; only slight changes occurred during the anastomosis of the left anterior descending coronary artery. Conclusions. Arterial pulse-contour analysis is easy to use and minimally invasive, thus qualifies as a reliable routine monitoring tool during minimally invasive coronary surgery with tissue stabilizers.

Measurement of cardiac output in infants less than 10 kg: accuracy of femoral artery thermodilution as compared to direct Fick

Femoral artery thermodilution (FATD) has proven a useful technique for the measurement of cardiac output (CO) in children as it avoids the problems associated with pulmonary artery catheterisarion by placing the thermistor in the femoral artery. We wished to evaluate the accuracy of FATD using a commercially available device (COLD Z-021, Pulsion, Munich) amongst infants less than 10 kg.

Femoral artery catheterisation for cardiac output measurement using the femoral artery thermodilution technique does not compromise limb perfusion

Femoral artery catheterisation for cardiac output measurement using the femoral artery thermodilution technique does not compromise limb perfusion

Clinicians’ abilities to estimate cardiac index in ventilated children and infants

OBJECTIVESTo 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...