Pediatric Intensive Care Unit, Department of Pediatrics, Hospital de Clínicas, Universidade Estadual de Campinas - Campinas (SP), Brazil.
Crit Care Sci. 2023 Mar 1;35(1):107-111. doi: 10.5935/2965-2774.20230305-en.
Cardiac output is an essential determinant of oxygen delivery, although unreliably measured on clinical examination and routine monitoring. Unfortunately, cardiac output monitoring is rarely performed in pediatric critical care medicine, with a limited availability of accurate methods for children. Herein, we report two pediatric cases in which noninvasive pulse-wave transit time-based cardiac output monitoring (esCCO, Nihon Kohden, Tokyo, Japan) was used. The esCCO system calculates cardiac output continuously by using the negative correlation between stroke volume and pulse wave transit time and requires only electrocardiogram monitoring, noninvasive blood pressure, and pulse oximetry signals. Before starting its use, esCCO should be calibrated, which can be done using patient information (gender, age, height, and body weight) or entering cardiac output values obtained by other methods. In both cases, when calibrations were performed using patient information, the agreement between esCCO and echocardiographic measurements was poor. However, after calibration with transthoracic echocardiography, the cardiac output values obtained by both methods remained similar after 2 hours and 18 hours. The results indicate that the esCCO system is suitable for use in children; however, further studies are needed to optimize its algorithm and determine its accuracy, precision, and trend in children.
心输出量是氧输送的一个重要决定因素，尽管在临床检查和常规监测中不可靠。不幸的是，心输出量监测在儿科重症监护医学中很少进行，因为儿童可用的准确方法有限。本文报告了两例使用基于无创脉搏波传导时间的心输出量监测（esCCO，日本光电工业株式会社，东京）的儿科病例。esCCO 系统通过使用每搏量和脉搏波传导时间之间的负相关关系连续计算心输出量，仅需要心电图监测、无创血压和脉搏血氧饱和度信号。在开始使用之前，esCCO 应该进行校准，可以使用患者信息（性别、年龄、身高和体重）或输入其他方法获得的心输出量值进行校准。在这两种情况下，当使用患者信息进行校准时，esCCO 与超声心动图测量值之间的一致性很差。然而，在经胸超声心动图校准后，两种方法获得的心输出量值在 2 小时和 18 小时后仍保持相似。结果表明，esCCO 系统适用于儿童；然而，需要进一步研究来优化其算法，并确定其在儿童中的准确性、精密度和趋势。
