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