Skip to main content
Log in

Accuracy and repeatability of pediatric cardiac output measurement using Doppler: 20-year review of the literature

  • Review
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

Review of the accuracy and repeatability of Doppler cardiac output (CO) measurements in children.

Design

Publications in the scientific literature retrieved using a computerized Medline search from 1982–2002 and a manual review of article bibliographies. Studies comparing Doppler flow measurements with thermodilution, Fick, or dye dilution methods in the pediatric critical care setting were identified to assess the bias, precision, and intra- and interobserver repeatability of Doppler CO measurement. Where results were not suitable for comparison and the original measurements available, data were re-analyzed using appropriate statistical methods and presented in comparative tables.

Results

The precision of pediatric Doppler CO measurements compared to thermodilution, dye dilution, or Fick methods is around 30% and repeatability varies from less than 1% to 22%. Bias is generally less than 10% but varies considerably.

Conclusions

The bias, precision, and repeatability from study to study indicate that Doppler CO measurements are acceptably reproducible in children, with best results when used to track changes rather than absolute values, and using the transesophageal approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tibby SM, Hatherill M, Marsh MJ, Murdoch IA (1997) Clinicians' abilities to estimate cardiac index in ventilated children and infants. Arch Dis Child 77:516–518

    CAS  PubMed  Google Scholar 

  2. Richardson JR, Ferguson J, Hiscox J, Rawles J (1998) Non-invasive assessment of cardiac output in children. J Accid Emerg Med 15:304–307

    CAS  PubMed  Google Scholar 

  3. Boyd O, Grounds RM, Bennett ED (1993) A randomised clinical trial of the effect if deliberate increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270:2699–2707

    CAS  PubMed  Google Scholar 

  4. Shoemaker WC, Kram HB, Appel PL, Fleming AW (1990) The efficacy of central venous and pulmonary artery catheters and therapy based upon them in reducing mortality and morbidity. Arch Surg 125:1332–1338

    CAS  PubMed  Google Scholar 

  5. Bishop MH, Shoemaker WC, Appel PL, Meade P, Ordog GJ, Wasserberger J, Wo CJ, Rimle DA, Kram HB, Umali R (1995) Prospective, randomised trial of survivor values of cardiac index, oxygen delivery and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 38:780–787

    CAS  PubMed  Google Scholar 

  6. Hayes MA, Timmins AC, Yau EHS, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722

    CAS  PubMed  Google Scholar 

  7. Gattitoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333:1025–1032

    CAS  PubMed  Google Scholar 

  8. Thompson AE (1997) Pulmonary artery catheterizaton in children. New Horiz 5:244–250

    CAS  PubMed  Google Scholar 

  9. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 8476:307–310

    Google Scholar 

  10. Wodey E, Gai V, Carre F, Ecoffey C (2001) Accuracy and limitations of continuous oesophageal aortic blood flow measurement during general anaesthesia for children: comparison with transcutaneous echography-Doppler. Paediatr Anaesth 11:309–317

    CAS  PubMed  Google Scholar 

  11. Tibby SM, Hatherill M, Murdoch IA (2000) Use of transesophageal Doppler ultrasonography in ventilated pediatric patients: derivation of cardiac output. Crit Care Med 28:2045–2050

    Google Scholar 

  12. Murdoch IA, Marsh MJ, Tibby SM, McLuckie A (1995) Continuous haemodynamic monitoring in children: use of transoesophageal Doppler. Acta Paediatr 84:761–764

    CAS  PubMed  Google Scholar 

  13. Mohan UR, Britto J, Habibi P, deMunter C, Nadel S (2002) Noninvasive measurement of cardiac output in critically ill children. Pediatr Cardiol 23:58–61

    CAS  PubMed  Google Scholar 

  14. Critchley LAH and Critchley JA (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15:85–91

    Article  CAS  PubMed  Google Scholar 

  15. Mellander M, Sabel K, Caidahl K, Solymar L, Eriksson B (1987) Doppler determination of cardiac output in infants and children: comparison with simultaneous thermodilution. Pediatr Cardiol 8:241–246

    CAS  PubMed  Google Scholar 

  16. Sholler GF, Whight CM, Celermajer JM (1986) Pulsed Doppler echocardiographic assessment, including use of aortic leaflet separation, of cardiac output in children with structural heart disease. Am J Cardiol 57:1195–1197

    CAS  PubMed  Google Scholar 

  17. Notterman DA, Castello FV, Steinberg C, Greenwald BM, O'Loughlin JE, Gold JP (1988) A comparison of thermodilution and pulsed Doppler cardiac output measurement in critically ill children. J Pediatr 115:554–560

    Google Scholar 

  18. Morrow WR, Murphy DJ, Fisher DJ, Huhta JC, Jefferson LS, O'Brian Smith E (1988) Continuous wave Doppler cardiac output: use in pediatric patients receiving inotropic support. Pediatr Cardiol 9:131–136

    CAS  PubMed  Google Scholar 

  19. Tibballs J, Osborne A, Hockmann M (1988) A comparative study of cardiac output measurement by dye dilution and pulsed Doppler ultrasound. Anaesth Intensive Care 16:272–277

    PubMed  Google Scholar 

  20. Wipperman CF, Schranz D, Huth R, Zepp F, Oelert H, Jungst B (1992) Determination of cardiac output by an angle and diameter independent dual beam Doppler in critically ill infants. Br Heart J 67:180–184

    PubMed  Google Scholar 

  21. Rein A, Hsieh K, Elixaon M, Colan S, Lang P, Sanders S, Casteneda A (1986) Cardiac output estimates in the pediatric intensive care unit using a continuous wave Doppler computer: validation and limitations of the technique. Am Heart J 112:97–102

    CAS  PubMed  Google Scholar 

  22. Darmon PL, Hillel Z, Mogtader A, Mindich B, Thys D (1994) Cardiac outout by transesophageal echocardiography using continuous wave Doppler across the aortic valve. Anesthesiology 80:796–805

    CAS  PubMed  Google Scholar 

  23. Hudson I, Hudson A, Aitchison T, Holland B, Turner T (1990) Reproducibility of measurements of cardiac output in newborn infants by Doppler ultrasound. Arch Dis Child 65:15–19

    CAS  PubMed  Google Scholar 

  24. Claflin KS, Alverson DC, Pathak D, Angelus P, Backstrom C, Werner S (1988) Cardiac output determination in the newborn: reproducibility of the pulsed Doppler velocity measurement. J Ultrasound Med 7:311–315

    CAS  PubMed  Google Scholar 

  25. Hanseus K, Björkhem G, Lundström NR (1994) Cardiac function in healthy infants and children: Doppler echocardiographic evaluation. Pediatr Cardiol 15:211–218

    CAS  PubMed  Google Scholar 

  26. Childs C, Goldring S, Tann W, Hillier VF (1998) Suprasternal Doppler ultrasound for assessment of stroke distance. Arch Dis Child 79:251–255

    CAS  PubMed  Google Scholar 

  27. Hirsimaki K, Kerp P, Seppala T, Holstrom K (1993) Mean or maximum velocity using pulsed Doppler ultrasound in determination of Doppler derived cardiac output in the newborn infant. Med Biol Eng Comput 31:58–56

    CAS  PubMed  Google Scholar 

  28. Chew MS, Brandberg J, Bjarum S, Baek Jensen K, Sloth E, Ask P, Hasenkam JM, Janerot Sjöberg B (2000) Pediatric cardiac output measurement using surface integration of velocity vectors: an in vivo validation study. Crit Care Med 28:3664–73661

    CAS  PubMed  Google Scholar 

  29. Welch E, Duara S, Suguihara C, Bandstra E, Bancalari E (1994) Validation of cardiac output measurements with noninvasive Doppler echocardiography by thermodilution and Fick methods in newborn piglets. Biol Neonate 66:137–145

    CAS  PubMed  Google Scholar 

  30. Stevenson J (1999) Incidence of complications in pediatric transesophageal echocardiography: experience in 1650 cases. J Am Soc Echocardiogr 12:527–532

    CAS  PubMed  Google Scholar 

  31. Wallace AW, Salahieh A, Lawrence A, Spector K, Owens C, Alonso D (2000) Endotracheal cardiac output monitor Anesthesiology 92:178–189

    CAS  Google Scholar 

  32. Alverson DC, Eldridge M, Dillon T, Yabek SM, Berman W (1982) Noninvasive pulsed Doppler determination of cardiac output in neonates and children. J Pediatr 101:46–50

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michelle S. Chew.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chew, M.S., Poelaert, J. Accuracy and repeatability of pediatric cardiac output measurement using Doppler: 20-year review of the literature. Intensive Care Med 29, 1889–1894 (2003). https://doi.org/10.1007/s00134-003-1967-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-003-1967-9

Keywords

Navigation