Dados do Trabalho

Título

Evaluation of Non-Invasive Pulse-Wave Transit Time-Based Cardiac Output Monitoring (esCCO) in Critically Ill Children: A Comparison with Transthoracic Echocardiography

Objetivo

To assess the agreement between cardiac index (CI) values obtained through continuous non-invasive cardiac output monitoring based on pulse wave transit time (esCCO, Nihon Koden, Tokyo, Japan) and transthoracic echocardiography in critically ill children.

Métodos

A prospective observational study involving mechanically ventilated patients, where CI measurements were performed using echocardiography (gold standard) and esCCO. Initially (T0), the esCCO was calibrated using patient demographic data (age, weight, and gender). Soon after, the esCCO was recalibrated with the cardiac index values obtained through echocardiography, and new measurements were taken after 2 hours (T1) and 18 hours (T2). The average of three echocardiographic cardiac output measurements at each time point was used for analysis. The agreement between values obtained by the two methods was assessed using Lin's concordance correlation coefficient (CCC).

Resultados

Fifty patients were included, with a median age of 7.5 months [interquartile range (IQR): 3 to 54 months] and a body surface area of 0.35 m² (IQR: 0.27 to 0.69 m²). In the pre-calibration phase (T0), the CCC was 0.05 [95% confidence interval (CI): 0 to 0.1]. At T1 and T2, the CCCs were 0.88 (95% CI: 0.8 to 0.93) and 0.66 (95% CI: 0.48 to 0.79), respectively.

Conclusão

The esCCO does not agree with echocardiographic values when calibrated using children's demographic data. However, after calibration with echocardiographic values, the esCCO shows good agreement 2 hours post-calibration and reasonable agreement after 18 hours. Thus, esCCO seems to be a valuable non-invasive tool for cardiac output monitoring in critically ill children.