Clinicians’ abilities to estimate cardiac index in ventilated children and infants
Open accessAbstract
OBJECTIVES: To evaluate the ability of clinicians involved in the provision of paediatric intensive care to estimate cardiac index in ventilated children, based on physical examination and clinical and bedside laboratory data. METHODS: Clinicians were exposed to all available haemodynamic and laboratory data for each patient, allowed to make a physical examination, and asked to first categorize cardiac index as high, high to normal, low to normal, or low, and then to quantify this further with a numerical estimate. Cardiac index was measured simultaneously by femoral artery thermodilution (coefficient of variation 5.37%). One hundred and twelve estimates were made by 27 clinicians on 36 patients (median age 34.5 months). RESULTS: Measured cardiac index ranged from 1.39 to 6.84 1/min/m2. Overall, there was poor correlation categorically (kappa statistic 0.09, weighted kappa 0.169) and numerically (r = 0.24, 95% confidence interval 0.06 to 0.41), although some variation was seen among the various levels of seniority. CONCLUSION: Assuming that objective measurement, and hence manipulation, of haemodynamic variables may improve outcome, these findings support the need for a safe, accurate, and repeatable technique for measurement of cardiac index in children who are critically ill.
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Low cardiac output state is accurately clinically recognized in only 25% of cases in pediatric intensive care units.
“Low cardiac output state is accurately clinically recognized in only 25% of cases in pediatric intensive care units [10].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [10]
Table 1 (Discussion; page unavailable) shows that clinicians correctly classified 12 of 47 measured low-cardiac-index estimates as low—about 25%. The Patients and methods section specifies that these estimates concerned ventilated, sedated children, so the result does not establish a 25% recognition rate for all pediatric intensive care patients. (LLM, conf=0.85)
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“Low cardiac output state is accurately clinically recognized in only 25% of cases in pediatric intensive care units [10].”
- Authors
- Tibby, S. M., Hatherill, M., Marsh, M. J., & Murdoch, I. A.
- Affiliations
- Guy's Hospital (GB)
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 1997-12-01
- Volume
- 77
- Issue
- 6
- Pages
- 516-518
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- PMC
- PMC1717412
- OpenAlex
- W2005219150
- Cited by
- 224
- References
- 22
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 9 · 2023: 10 · 2022: 6 · 2021: 3 · 2020: 18 · 2019: 12 · 2018: 10 · 2017: 10 · 2016: 15 · 2015: 11 · 2014: 9 · 2013: 19 · 2012: 10
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- cardiac index, pediatric intensive care, mechanically ventilated children, infants, hemodynamic assessment, thermodilution, physical examination
- MeSH terms
- Body Surface Area, Cardiac Output, Child, Child, Preschool, Clinical Competence, Humans, Infant, Respiration, Artificial, Thermodilution, Intensive Care Units, Pediatric
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