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Table 4 Recommendations on use of serum lactate, near infrared spectroscopy (NIRS), and microcirculation assessment for 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
Serum lactate measurement
 1. We recommend to obtain a repeat blood sample from a reliable site when the lactate value of a capillary sample is higher than 3.0 mmol/L and to closely follow-up patients and intensify treatment until lactate values at least drop below 3.0 mmol/L, especially if other concerns regarding tissue hypoxia are present. Strong agreement
 2. We recommend to interpret lactate levels always in conjunction with clinical indicators of poor systemic perfusion and monitoring parameters. Strong agreement
Near infrared spectroscopy
 3. Trend in NIRS values may provide valuable physiological information in children with hemodynamic instability but routine use in all children with hemodynamic instability is not recommended. Strong agreement
 4. Near infrared spectroscopy (NIRS) can be useful during the peri-operative period after surgery for congenital heart defects; however, we recommend against the routine use of NIRS during non-cardiac surgery. Weak agreement
 5. Many routinely used parameters like capillary refill, peripheral temperature, lactate, NIRS etc., reflect aspects of the hemodynamic condition, but they do not adequately reflect the microcirculation. Although central venous to arterial CO2 difference could provide additional insight into the microcirculatory condition, we recommend against its use to guide resuscitation in critically ill children Strong agreement
 6. We recommend against routine microcirculation evaluation by video microscopy in stable children except those in clinical studies Strong agreement