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Pulse contour cardiac output monitoring is less reliable in critically ill children

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Intermittent cardiac output measurement using the transpulmonary thermodilution (TPTD) method is considered to be the gold standard in young children but a validated continuous cardiac output technique is not available in these patients. We compared the continuous pulse contour cardiac output (PCCO) measurements with the TPTD method in critically ill children.


We compared PCCO, measured with the PiCCO device (Pulsion, Munich, Germany), with TPTD measurements (COTPTD) using the same device in a general pediatric intensive care (PICU) population. Because PCCO is calibrated with each TPTD measurement (COTPTD) we compared the mean PCCO value just before a new TPTD measurement was done. We approved only COTPTD measurement consisting of three consecutive TPTD measurements and we checked the thermodilution curve for a temperature difference of at least 0.2°C and a normal appearance. Only the intervals between two approved series of TPTD measurements were analysed. We calculated the correlation coefficient and used the Bland-Altman method for analysis.


Sixty-one measurements in 10 children were included. Mean age was 24.5 (range 5 to 123) months; mean weight was 11.2 (range 3.8 to 18) kg, mean heart rate was 131/minute (range 87 to 193) and the mean blood pressure was 73 (range 49 to 96) mmHg. The mean COTPTD was 2.60 (range 0.66 to 5.64) l/minute, mean cardiac index was 5.16 (range 2.76 to 10.83) l/minute/m2 and mean duration of the interval was 5 hours and 33 minutes (range 14 minutes to 15 hours). The correlation coefficient between the COTPTD and PCCO was 0.85 (P < 0.0001). The Bland-Altman analysis showed a mean bias of 0.06 l/minute (limits of agreement (LoA) ± 2.22 l/minute) (Figure 1). The percentage error was 43%. The correlation coefficient between the recalibration interval and the bias between COTPTD and PCCO was -0.26 (P = 0.05). There was no correlation between COTPTD and PCCO (r = 0.09 (P = 0.57)).

Figure 1

Bland-Altman analysis of CO TPTD and PCCO.


The PCCO method cannot replace the transpulmonary thermodilution method in critically ill children.

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Correspondence to JC Verheul.

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Verheul, J., Nusmeier, A. & Lemson, J. Pulse contour cardiac output monitoring is less reliable in critically ill children. Crit Care 16, P220 (2012).

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  • Transpulmonary Thermodilution
  • Cardiac Output Measurement
  • Continuous Cardiac Output
  • Thermodilution Method
  • Continuous Pulse