Evaluation of a noninvasive cardiac output monitor in mechanically ventilated children

Abstract

Objective: To compare measurements of cardiac output (CO) and cardiac index (CI) obtained by a recently developed noninvasive continuous cardiac output system, NICO (CONICO), and trans-thoracic Doppler echocardiography (COTTE) in mechanically ventilated children. Design and Setting: Prospective study in a university-affiliated tertiary pediatric intensive care unit. Patients: A total of 21 mechanically ventilated children, weighing >15 kg, in stable respiratory and hemodynamic condition. Measurements: Sets of three successive measurements of CO with the NICO system and transthoracic Doppler echocardiography were obtained. Bland-Altman analysis was used to compare the agreement between the two methods. Results: The mean ± SD CO values were 4.06 ± 1.43 L/min for CONICO and 4.67 ± 1.78 L/min for COTTE. Bias ± SD between the two methods was -0.61 ± 0.94 L/min. The variability of the difference between the two methods increased as the magnitude of the CO measurement increased. Similar results were obtained for cardiac index: 4.01 ± 1.40 L·min-1·m -2 for CINICO and 4.59 ± 1.48 L·min -1·m-2 for CITTE. Bland-Altman analysis revealed a nonuniform relationship between CI difference and the magnitude (y = -0.299 - 0.0655 x mean). The variability of the differences did not increase as the magnitude of the CO measurement increased (SD of estimate was 0.827 L·min-1·m-2). With both CONICO and CINICO, each measurement was highly repeatable, with coefficient of variation of only 2.88% ± 2.31%. Repeatability with Doppler echocardiography was 7.02% ± 4.33%. Conclusions: The NICO system is a new device that measures CO easily and automatically in mechanically ventilated children weighing >15 kg. CO values obtained with this technique were in agreement with those obtained with Doppler echocardiography in children in respiratory and hemodynamic stable condition. The NICO system needs further investigation in children in unstable respiratory and hemodynamic condition. Copyright © 2006 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.