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Paediatric Haematology
As a result of the above, care must be taken to direct therapy based Although arterial catheters are the standard of care in adult and
on APCCO in children. Technologies with built-in and proven reliable paediatric intensive care, their use in children is more difficult.
calibration seem most appropriate at this moment. Therefore, a non-invasive APCCO technique would be of great benefit.
A completely non-invasive APCCO technique already exists. Based on
Future Perspectives the former finapres method the Nexfin device (BMEYE, Amsterdam,
Although the application of the APCCO method in adults is evolving The Netherlands) already provides an uncalibrated continuous blood
and seems to be gaining reliability, its development in children pressure and cardiac output using just a finger cuff. Validation of
advances more slowly. This may be because of technical difficulties Nexfin CO in adults is promising.
regarding specific paediatric characteristics and validation problems. A
This technology even has a potential benefit over intra-arterial pressure
wave systems because it is not hampered by damping of the pressure
signal or technical problems with fluid filled pressure recording
Although arterial catheters are the
systems. However, this technique is currently not available for small
children. Beta-type small finger cuffs and specially adapted software
standard of care in adult and paediatric
have been tested in children with promising results.
32
However, further
intensive care, their use in children is
technical developments and more clinical studies are needed.
more difficult.
Conclusion
APCCO monitoring is an evolving technique in adult critical care
medicine and anaesthesia. However, in children its performance is still
questionable. Much work needs to be done to further adapt
lack of financial benefit in designing these systems for a small subset algorithms for the paediatric population. Current APCCO systems in
of patients may play an important role. This would be unfortunate children need to be used with caution and should preferably include a
because it is specially in critically ill children where a minimally invasive known reliable calibration method. Less invasive systems are currently
cardiac output technique is most wanted. in development. ■
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96 EUROPEAN HAEMATOLOGY
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