Noninvasive Continuous Cardiac Output Monitoring In Shocked Children: Validity & Age Difference Of Estimated Continuous Cardiac Output

Abstract

Background: Shock in pediatric patients leads to significant morbidity and mortality if not promptly recognized and managed. Continuous cardiac output (CO) monitoring is crucial in guiding treatment, but traditional methods are invasive. Estimated continuous cardiac output (esCCO) offers a noninvasive alternative using pulse wave transit time.

Aim: To assess the accuracy of esCCO compared to transthoracic echocardiography (TTE) for CO monitoring in critically ill children with shock, and to explore the effect of age on its validity.

Methods: This prospective observational study included 110 pediatric patients (aged 1 month to 12 years) admitted to the ICU with shock. CO was measured using esCCO and TTE on admission, at 24 hours, and at 48 hours. Clinical data, vasoactive use, and outcomes were recorded. Correlation and agreement between esCCO and TTE measurements were analyzed using Spearman’s test and Bland–Altman analysis.

Results: A strong correlation between esCCO and TTE was observed among children older than 7 years at all-time points (r > 0.9, p < 0.001). Agreement was poor among younger children. esCI did not significantly change over time, while esSV declined among children <7 years (p = 0.03). Mortality was weakly associated with lower esCI and higher esSV. ROC analysis showed esCI had poor predictive value for mortality (AUC = 0.626).

Conclusion:esCCO correlates well with TTE in older children and can serve as a reliable noninvasive tool for CO monitoring in this subgroup. Its utility in younger children remains limited.