title: Clinicians' abilities to estimate cardiac index in ventilated children and infants.
abstract: OBJECTIVE
  To evaluate the ability of clinicians involved in the provision of paediatric intensive care to estimate cardiac index in ventilated children, based on physical examination and clinical and bedside laboratory data.
  
  
  METHODS
  Clinicians were exposed to all available haemodynamic and laboratory data for each patient, allowed to make a physical examination, and asked to first categorize cardiac index as high, high to normal, low to normal, or low, and then to quantify this further with a numerical estimate. Cardiac index was measured simultaneously by femoral artery thermodilution (coefficient of variation 5.37%). One hundred and twelve estimates were made by 27 clinicians on 36 patients (median age 34.5 months).
  
  
  RESULTS
  Measured cardiac index ranged from 1.39 to 6.84 1/min/m2. Overall, there was poor correlation categorically (kappa statistic 0.09, weighted kappa 0.169) and numerically (r = 0.24, 95% confidence interval 0.06 to 0.41), although some variation was seen among the various levels of seniority.
  
  
  CONCLUSIONS
  Assuming that objective measurement, and hence manipulation, of haemodynamic variables may improve outcome, these findings support the need for a safe, accurate, and repeatable technique for measurement of cardiac index in children who are critically ill.
authors.affiliation: Department of Paediatric Intensive Care, Guy's Hospital, London.
authors.forename: S M
authors.initials: SM
authors.lastname: Tibby
authors.forename: M
authors.initials: M
authors.lastname: Hatherill
authors.forename: M J
authors.initials: MJ
authors.lastname: Marsh
authors.forename: I A
authors.initials: IA
authors.lastname: Murdoch
mesh_terms: D001830:Body Surface Area; D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D012121:Respiration, Artificial; D013815:Thermodilution