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