NONINVASIVE MONITORING OF CRITICALLY ILL CHILD

nmcickapak

NONINVASIVE CARDIAC MONITORING IN CRITICALLY ILL CHILD

Neslihan Zengin

Manisa Celal Bayar University, Faculty of Medicine, Department of Pediatric Intensive Care, Manisa, Türkiye

Zengin N. Noninvasive Cardiac Monitoring in Critically Ill Child. In: Bal A, editor. Noninvasive Monitoring of Critically Ill Child. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.13-22.

ABSTRACT

The management of critically ill children requiring intensive care relies on a detailed assessment of their cardiovascular status. In clinical practice, routine observations of vital signs, such as heart rate, blood pressure, and capillary refill time, combined with indirect perfusion measures, including serum lactate and urine output, are utilised to assess patients’ hemodynamic status. However, such assessment methods often have limitations in detecting early signs of cardiovascular deterioration and distinguish- ing underlying pathophysiology (cardiogenic or vascular). Reliable and continuous cardiac output (CO) monitoring facilitates early recognition of deterioration and enables targeted, individualised fluid and vasoactive agent management in such children. Transthoracic echocardiography (TTE) is utilised to assess cardiac function and support decision-making processes in patient care. However, TTE is operator-dependent and performed intermittently, requiring extensive training. In paediatric patients, reference methods such as thermodilution or the Fick principle are invasive and may lead to compli- cations, including infection, thrombosis and vascular injury, limiting their practical use. Devices based on bioimpedance and ultrasound have been developed to monitor cardiac output continuously and noninvasively. Nonetheless, non-invasive monitoring faces technical challenges related to accuracy, sensitivity, and variability in response time. Notwithstanding these challenges, these methods offer a significant advantage in that invasive arterial or venous catheters are not required, associated with com- plications and risks. Noninvasive cardiac output (CO) and fluid responsiveness monitoring in critically ill children is a fascinating and evolving research domain. Innovative noninvasive CO monitors pres- ent a promising alternative to echocardiography. Despite ongoing challenges in assessing perfusion, recent advancements in noninvasive monitoring capabilities are poised to transform the landscape of critical care. However, further clinical research and validation studies are required before the routine implementation of these devices.

Keywords: Critically ill children; Noninvasive cardiac monitoring; Bioimpedance; Ultrasound

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