Skip to main content

Table 1 Recommendations on use of clinical examination and blood pressure measurement in hemodynamic monitoring in critically ill children

From: Recommendations for hemodynamic monitoring for critically ill children—expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

Sr No Recommendation Level of agreement
Clinical signs
 1. There is no single clinical parameter that allows to evaluate the global hemodynamic status in children and, therefore, we recommend to analyze several parameters and make frequent assessments. Strong agreement
 2. We recommend to perform a clinical assessment as the initial evaluation in all patients for the detection of hemodynamic alterations and to evaluate clinical signs periodically together with hemodynamic monitoring parameters in unstable patients. Strong agreement
 3. We do not recommend to titrate hemodynamic therapy or fluid loading solely based upon clinical signs or a reduced urine output alone in unstable patients with the exception of the initial resuscitation phase. Strong agreement
Arterial blood pressure
 4. We recommend the use of intra-arterial blood pressure (IBP) over oscillometric blood pressure (OBP) measurement when a reliable blood pressure (BP) measurement is of importance or when fast changes in blood pressure need to be detected. Strong agreement
 5. In children over 12 years of age we recommend a target blood pressure of ≥ 65 mmHg MAP (according to adults surviving sepsis guidelines) unless in children known to have prior hypertension. Strong agreement
 6. We recommend not to use BP as the only therapeutic target in unstable children. The hemodynamic state should be evaluated integrating several clinical and hemodynamic parameters. Strong agreement
 7. We recommend IBP monitoring in children in shock not responsive to initial fluid therapy or requiring vasopressor treatment, and hypertensive emergencies to control the effect of continuous invasive hypotensive drugs. Strong agreement