by Yogen Singh, Javier Urbano Villaescusa, Eduardo M. da
Cruz, Shane M. Tibby, Gabriella Bottari, Rohit Saxena, Marga Guillén, Jesus
Lopez Herce, Matteo Di Nardo, Corrado Cecchetti, Joe Brierley, Willem de Boode
and Joris Lemson
Critical Care volume 24,
Article number: 620 (2020)
Background
Cardiovascular instability is common in critically ill
children. There is a scarcity of published high-quality studies to develop
meaningful evidence-based hemodynamic monitoring guidelines and hence, with the
exception of management of shock, currently there are no published guidelines
for hemodynamic monitoring in children. The European Society of Paediatric and
Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to
provide expert consensus recommendations on hemodynamic monitoring in critically
ill children.
Methods
Creation of a panel of experts in cardiovascular hemodynamic
assessment and hemodynamic monitoring and review of relevant literature—a
literature search was performed, and recommendations were developed through
discussions managed following a Quaker-based consensus technique and evaluating
appropriateness using a modified blind RAND/UCLA voting method. The AGREE
statement was followed to prepare this document.
Results
Of 100 suggested recommendations across 12 subgroups concerning
hemodynamic monitoring in critically ill children, 72 reached “strong
agreement,” 20 “weak agreement,” and 2 had “no agreement.” Six statements were
considered as redundant after rephrasing of statements following the first
round of voting. The agreed 72 recommendations were then coalesced into 36
detailing four key areas of hemodynamic monitoring in the main manuscript. Due
to a lack of published evidence to develop evidence-based guidelines, most of
the recommendations are based upon expert consensus.
Conclusions
These expert consensus-based recommendations may be used to
guide clinical practice for hemodynamic monitoring in critically ill children,
and they may serve as a basis for highlighting gaps in the knowledge base to
guide further research in hemodynamic monitoring.
