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)
Yogen Singh,
Javier Urbano Villaescusa,
Eduardo M. da Cruz,
Shane M. Tibby,
Gabriella Bottari,
Rohit Saxena,
Marga Guillén,
Jesus Lopez Herce,
Matteo Di Nardo,
Corrado Cecchetti,
Joe Brierley,
Willem de Boode,
Joris Lemson
Affiliations
Yogen Singh
Department of Pediatrics - Neonatology and Pediatric Cardiology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine
Javier Urbano Villaescusa
Department of Pediatric Intensive Care, Gregorio Marañón Hospital University Hospital
Eduardo M. da Cruz
Department of Pediatrics, Children’s Hospital Colorado, Section of Cardiac Intensive Care, The Heart Institute
Shane M. Tibby
Department of Pediatric Intensive Care, Evelina London Children’s Hospital
Gabriella Bottari
Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù-IRCC
Rohit Saxena
Department of Pediatric and Cardiac Intensive Care, Great Ormond Street Hospital for Children and UCL Institute for Child Health
Marga Guillén
Department of Pediatric Intensive Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust
Jesus Lopez Herce
Department of Pediatric Intensive Care, Gregorio Marañón Hospital University Hospital
Matteo Di Nardo
Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù-IRCC
Corrado Cecchetti
Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù-IRCC
Joe Brierley
Department of Pediatric and Cardiac Intensive Care, Great Ormond Street Hospital for Children and UCL Institute for Child Health
Willem de Boode
Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children’s Hospital
Joris Lemson
Department of Intensive Care Medicine, Radboud University Medical center, Radboud Institute for Health Sciences
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.
