Monitoring cardiac function in intensive care.
Systolic cardiac function results from the interaction of four interdependent factors: heart rate, preload, contractility, and afterload. Heart rate can be quantified easily at the bedside, while preload estimation has traditionally relied on invasive pressure measurements, both central venous and pulmonary artery wedge. These have significant clinical limitations; however, adult literature has highlighted the superiority of several novel preload measures. Measurement of contractility and afterload is difficult; thus in clinical practice the bedside assessment of cardiac function is represented by cardiac output. A variety of techniques are now available for cardiac output measurement in the paediatric patient. This review summarises cardiac function and cardiac output measurement in terms of methodology, interpretation, and their contribution to the concepts of oxygen delivery and consumption in the critically ill child.
Tibby
S M
SM
Department of Paediatric Intensive Care, Guy's Hospital, London SE1 9RT, UK. Shane.Tibby@gstt.sthames.nhs.uk
Murdoch
I A
IA
D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output; D002648:Child; D006339:Heart Rate; D006801:Humans; D015278:Intensive Care Units, Pediatric; D019344:Lactic Acid / Q000097:blood; D008991:Monitoring, Physiologic / Q000379:methods*; D009200:Myocardial Contraction; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D010102:Oxygen Inhalation Therapy
D015415:Biomarkers; D019344:Lactic Acid; D010100:Oxygen