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)
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Abstract
BACKGROUND: Cardiovascular instability is common in critically ill children. There is a scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children. METHODS: Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature-a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document. RESULTS: Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached "strong agreement," 20 "weak agreement," and 2 had "no agreement." Six statements were considered as redundant after rephrasing of statements following the first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to a lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus. CONCLUSIONS: These expert consensus-based recommendations may be used to guide clinical practice for hemodynamic monitoring in critically ill children, and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.
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The ESPNIC committee on hemodynamic monitoring recommends the employment of NIRS during the peri-operative period after surgery for congenital heart defects.
“The ESPNIC committee on hemodynamic monitoring recommends the employment of NIRS during the peri-operative period after surgery for congenital heart defects [12].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [12]
Table 4 says NIRS can be useful during the peri-operative period after surgery for congenital heart defects, with weak agreement. That supports the setting and potential use, but the claim’s wording that the committee recommends employing NIRS is stronger than the source’s qualified statement. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere is still no universally accepted lower threshold guiding intervention and no consensus on the clinical utility of a decline of cerebral oxygen saturation < 40% or a change in baseline > 20%.
“For this reason, there is still no universally accepted lower threshold guiding intervention and no consensus on the clinical utility of a decline of cerebral oxygen saturation < 40% or a change in baseline > 20% [12].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [12]
The Near-infrared spectroscopy section says clear cut-off values are lacking and reports no agreement on the clinical usefulness of a cerebral rSO2 decline below 40–50% or a change from baseline of more than 20%. This supports the lack of an accepted threshold and the baseline-change figure, but the cited paper gives a 40–50% range rather than the claim’s specific <40% threshold. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAverage ScO2 values range between approximately 65 and 70% in both term and preterm neonates, in comparison to 46-57% in patients with cyanotic congenital heart disease.
“Average ScO2 values range between approximately 65 and 70% in both term and preterm neonates [68,69], in comparison to 46–57% in patients with cyanotic congenital heart disease [12].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [12]
The most recent ESPNIC consensus states that CVP should not be employed as a standalone parameter to guide fluid therapy, and that its interpretation requires a thorough understanding of its inherent limitations.
“The most recent ESPNIC consensus on hemodynamic monitoring states that CVP should not be employed as a standalone parameter to guide fluid therapy, and that its interpretation requires a thorough understanding of its inherent limitations [12].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [12]
The most recent ESPNIC consensus advises against relying solely on blood pressure as a therapeutic target in hemodynamically unstable children, instead advocating for a comprehensive assessment that integrates blood pressure with a range of clinical and paraclinical parameters.
“The most recent consensus statement from the Cardiovascular Dynamics Section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) advises against relying solely on blood pressure as a therapeutic target in hemodynamically unstable children, instead advocating for a comprehensive assessment that integrates blood pressure with a range of clinical and paraclinical parameters [12]”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [12]
The most recent ESPNIC consensus for hemodynamic monitoring in critically ill children recommends the echocardiographic measurement of cardiac output in clinical practice.
“The most recent ESPNIC consensus for hemodynamic monitoring in critically ill children recommends the echocardiographic measurement of cardiac output in clinical practice [12].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [12]
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Nedelcu, C., Ionescu, N. S., Bizubac, A. M., Filip, C., & Cirstoveanu, C. (2025) · Life · doi:10.3390/life15101621 · Cited by 2 · see citing works
“…Pediatric and Neonatal Intensive Care (ESPNIC) advises against relying solely on blood pressure as a therapeutic target in hemodynamically unstable children, instead advocating for a comprehensive assessment that integrates blood pressure with a range of clinical and paraclinical parameters [12].”
Influential
- Authors
- Singh, Y., Villaescusa, J. U., da Cruz, E. M., Tibby, S. M., Bottari, G., Saxena, R., Guillén, M., Herce, J. L., Di Nardo, M., Cecchetti, C., Brierley, J., de Boode, W., & Lemson, J.
- Affiliations
- University of Cambridge (GB)
- Evelina London Children's Healthcare (GB)
- Bambino Gesù Children's Hospital (IT)
- Great Ormond Street Hospital (GB)
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- Radboud University Medical Center (NL)
- Corresponding author
- Singh, Yogen
- Venue
- Critical Care
- Published
- 2020-10-22
- Volume
- 24
- Issue
- 1
- Pages
- 620-620
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC7579971
- OpenAlex
- W3094074521
- Cited by
- 86
- References
- 79
- Citations by year
- 2026: 15 · 2025: 19 · 2024: 10 · 2023: 21 · 2022: 16 · 2021: 4 · 2020: 1
- FWCI
- 9.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Apollo (cc-by)
- Apollo
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Keywords
- hemodynamic monitoring, critically ill children, pediatric intensive care, cardiovascular instability, hemodynamic assessment, expert consensus recommendations, pediatric shock, cardiovascular dynamics
- MeSH terms
- Hemodynamic Monitoring, Humans, Infant, Infant, Newborn, Pediatrics, Critical Illness, Consensus
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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