Hemodynamic monitoring in pediatric cardiac critical care
Open accessAbstract
Effective hemodynamic monitoring is essential in the pediatric cardiac intensive care unit for the early detection and management of shock. Clinical evaluation using vital signs, urine output, lactate levels, and base deficit provides initial insight into the balance between oxygen delivery and consumption. Advances in noninvasive techniques, such as enhanced transthoracic echocardiography (incorporating tissue Doppler imaging, three-dimensional imaging, and speckle tracking) and microcirculatory imaging, enable detailed, real-time assessment of cardiac output, preload, and tissue perfusion without the risks associated with invasive catheterization. In cases where noninvasive data are insufficient, invasive methods such as transpulmonary thermodilution and pulse contour analysis (e.g., PiCCO) provide continuous and accurate measurements of cardiac output, global end-diastolic volume, and extravascular lung water. This review addresses current evidence and emerging trends in hemodynamic monitoring, emphasizing the importance of integrating clinical assessments with both noninvasive and invasive modalities to guide targeted interventions and improve outcomes in critically ill children with heart disease.
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A narrow pulse pressure can be seen in low cardiac output states or during extracorporeal membrane oxygenation.
“A narrow pulse pressure can be seen in low cardiac output states or during extracorporeal membrane oxygenation (ECMO) [14].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [14]
Alterations of the arterial pressure waveform may indicate left ventricular dysfunction, cardiac tamponade, or aortic insufficiency.
“Alterations of the arterial pressure waveform may indicate left ventricular dysfunction, cardiac tamponade, or aortic insufficiency [14].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [14]
ECG monitoring following cardiac surgery allows the assessment of heart rate, pacemaker function, and detection of arrhythmias, myocardial ischemia, and acute ST-segment changes.
“Electrocardiographic (ECG) monitoring following cardiac surgery allows the assessment of heart rate, pacemaker function, and detection of arrhythmias, myocardial ischemia, and acute ST-segment changes, particularly after coronary artery reimplantation during procedures such as arterial switch operation [14].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [14]
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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
“…(ECG) monitoring following cardiac surgery allows the assessment of heart rate, pacemaker function, and detection of arrhythmias, myocardial ischemia, and acute ST-segment changes, particularly after coronary artery reimplantation during procedures such as arterial switch operation [14].”
InfluentialZhong, K., Lai, X., Zhang, J., Yang, X., Zheng, Z., Liao, G., Zhang, N. F., & Xu, Y. (2026) · BMC Anesthesiology · doi:10.1186/s12871-026-03671-9
- Authors
- Kumar, A., & Joshi, R. K.
- Affiliations
- Sir Ganga Ram Hospital (IN)
- Department of Pediatric Cardiac Sciences, Division of Pediatric Cardiac Anesthesia, Sir Ganga Ram Hospital, New Delhi, India
- Corresponding author
- Kumar, Anil
- ORCID
- Kumar, Anil
- Venue
- JOURNAL OF PEDIATRIC CRITICAL CARE
- Published
- 2025-05
- Volume
- 12
- Issue
- 3
- Pages
- 125-133
- ISSN
- 2349-6592 (ISSN-L)
- 2455-7099
- OpenAlex
- W4411240464
- Cited by
- 2
- References
- 36
- Citations by year
- 2026: 1 · 2025: 1
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- JOURNAL OF PEDIATRIC CRITICAL CARE (publishedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Keywords
- hemodynamic monitoring, pediatric cardiac intensive care, shock, cardiac output, transthoracic echocardiography, tissue Doppler imaging, transpulmonary thermodilution, PiCCO, extravascular lung water, lactate, base deficit, tissue perfusion, critically ill children
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