• Zaccaria Ricci, Giulia Cecconi, Rosa Lillo, Luca Di Chiara, Alessandra Toscano, and Roberta Iacobelli.
• Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy. Electronic address: z.ricci@libero.it.
• J. Cardiothorac. Vasc. Anesth. 2021 May 1; 35 (5): 1351-1357.

ObjectivesThis study aimed to compare, in a cohort of critically ill children with biventricular anatomy and no cardiovascular shunt, cardiac output (CO) and cardiac index (CI) assessed by echocardiography and a continuous pulse-contour method, MostCareUP, to measure the differences between these techniques (biasCO and biasCI), and their association with clinical variables.DesignRetrospective study.SettingTertiary pediatric cardiac intensive care unit.ParticipantsChildren admitted to the pediatric cardiac intensive care unit who underwent echocardiography with CO measurement.InterventionsNone.Measurements And Main ResultsThirty-five patients were included. BiasCO was -0.02 (0.26) L/min (percentage error 36%). BiasCI was 0.07 (0.34) L/min/m2 (percentage error 18%). Biases and percentage errors were higher in 24 nonsupervised echocardiographies. A negative biasCO (overestimation by MostCareUP) was associated with post-surgical status (v cardiomyopathy), higher systolic arterial pressure, and spontaneous breathing (v intubation). When only absolute values were considered, biasCONONEG correlated with age, weight, arterial pressure, and heart rate, whereas biasCINONEG was associated with a femoral arterial cannula, no use of inotropes, and the absence of mechanical ventilation. After adjustment, biasCONONEG remained independently associated with patients' body weight(p = 0.0001). BiasCINONEG showed a nonlinear relationship with weight below 20 kg and above 40 kg.ConclusionsChildren with extreme low or high weights, those who are extubated, and those with a femoral cannula carry the highest bias. When younger patients are considered, CI should be evaluated instead of CO, because biases are better highlighted by indexing data on body surface area. In children, both echocardiography and MostCareUP may be responsible of inaccurate CO/CI assessment.Copyright © 2020 Elsevier Inc. All rights reserved.

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