title: Cardiac output and systemic vascular resistance: Clinical assessment compared with a noninvasive objective measurement in children with shock.
abstract: To evaluate physician assessment of cardiac output and systemic vascular resistance in patients with shock compared with an ultrasonic cardiac output monitor (USCOM). To explore potential changes in therapy decisions if USCOM data were available using physician intervention answers.
  
  
  
  Double-blinded, prospective, observational study in a tertiary hospital pediatric intensive care unit. Forty children (<18years) admitted with shock, requiring ongoing volume resuscitation or inotropic support. Two to 3 physicians clinically assessed cardiac output and systemic vascular resistance, categorizing them as high, normal, or low. An investigator simultaneously measured cardiac index (CI) and systemic vascular resistance index (SVRI) with USCOM categorized as high, normal, or low.
  
  
  
  Overall agreement between physician and USCOM for CI (48.5% [κ = 0.18]) and SVRI (45.9% [κ = 0.16]) was poor. Interobserver agreement was also poor for CI (58.7% [κ = 0.33]) and SVRI (52.3% [κ = 0.28]). Comparing theoretical physician interventions to "acceptable" or "unacceptable" clinical interventions, based on USCOM measurement, 56 (21%) physician interventions were found to be "unacceptable."
  
  
  
  There is poor agreement between physician-assessed CI and SVRI and USCOM, with significant interobserver variability among physicians. Objective measurement of CI and SVRI may reduce variability and improve diagnostic accuracy.
authors.affiliation: Loma Linda University Medical Center, Loma Linda, CA.
authors.forename: Asma
authors.initials: A
authors.lastname: Razavi
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California Keck School of Medicine, Los Angeles, CA.
authors.forename: Christopher J L
authors.initials: CJL
authors.lastname: Newth
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California Keck School of Medicine, Los Angeles, CA.
authors.forename: Robinder G
authors.initials: RG
authors.lastname: Khemani
authors.affiliation: Nicklaus Children's Hospital, Miami, FL.
authors.forename: Fernando
authors.initials: F
authors.lastname: Beltramo
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California Keck School of Medicine, Los Angeles, CA. Electronic address: pross@chla.usc.edu.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D002302:Cardiac Output / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012772:Shock, Septic / Q000503:physiopathology*; D014655:Vascular Resistance / Q000502:physiology*; D055815:Young Adult
keywords: Cardiac output; Hemodynamic measurements; Sepsis; Shock; Systemic vascular resistance; USCOM