CONTINUOUS HEMODYNAMIC MONITORING IN CHILDREN - USE OF TRANSESOPHAGEAL DOPPLER

A wide range of invasive and non-invasive techniques for monitoring th e haemodynamic condition of critically ill patients is now available. A general reluctance on the part of paediatric intensive care speciali sts to use pulmonary artery thermodilution catheters and the need for constant realignment of hand-held Doppler probes has necessitated the search for a technique which is relatively non-invasive and provides c ontinuous information on the haemodynamic condition of critically ill paediatric patients. We sought to establish if transoesophageal Dopple r fulfilled these criteria. Eleven children who had recently undergone cardiac surgery were studied. Median age was 39 months and weight 14. 9 kg. Five simultaneous pairs of measurements of cardiac index (CI: th ermodilution) and minute distance (MD: transoesophageal Doppler) were made, as a baseline, when each child was haemodynamically stable. Foll owing a fluid challenge, five repeat pairs of measurements were made. The mean percentage changes for CI and MD were 16.4% (range 5.3-44%) a nd 16.6% (3.4-47.7%), respectively. The average coefficients of variat ion for measurements of CI and MD were 3.5% and 2.9%, respectively. Th e mean difference in percentage change between CI and MD was -0.5% (95 % confidence interval for the bias -4% to 3%; limits of agreement -10. 7 to +9.7%). Our study indicates that transoesophageal Doppler is repr oducible, easy to use and provides clinically acceptable information w hen following changes in CI in haemodynamically stable paediatric pati ents.