{"id":52342,"date":"2025-12-04T09:30:00","date_gmt":"2025-12-04T09:30:00","guid":{"rendered":"https:\/\/campusvygon.com\/uk\/?p=52342"},"modified":"2026-03-26T13:08:37","modified_gmt":"2026-03-26T13:08:37","slug":"advanced-haemodynamic-monitoring-and-cardiac-output-assessment-in-paediatric-patients","status":"publish","type":"post","link":"https:\/\/campusvygon.com\/uk\/anaesthesia-and-intensive-care\/advanced-haemodynamic-monitoring-and-cardiac-output-assessment-in-paediatric-patients\/","title":{"rendered":"Advanced Haemodynamic Monitoring and Cardiac Output Assessment in Paediatric Patients"},"content":{"rendered":"\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"576\" src=\"https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/shutterstock_1181842972-copy-1-1024x576.jpg\" alt=\"\" class=\"wp-image-52348\" srcset=\"https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/shutterstock_1181842972-copy-1-980x551.jpg 980w, https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/shutterstock_1181842972-copy-1-480x270.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) 1024px, 100vw\" \/><\/figure>\n\n\n\n<p><strong>By <\/strong><a href=\"https:\/\/campusvygon.com\/global\/author\/schindler\/\"><strong>Prof. Ehrenfried SCHINDLER<\/strong><\/a><\/p>\n\n\n\n<p><em>PRAM and MostCare are trademarks of Bio-Si International s.r.l.<\/em><\/p>\n\n\n\n<p>Haemodynamic monitoring is essential in paediatric peri-operative and critical care medicine,&nbsp;guiding adequate tissue perfusion and oxygen delivery&nbsp;in the most vulnerable patients. Although basic parameters in paediatric anaesthesia such as heart rate, blood pressure, and pulse&nbsp;oximetry play an essential role in routine peri-operative monitoring, their ability to accurately reflect&nbsp;Cardiac&nbsp;Output (CO) and global perfusion is limited.&nbsp;<\/p>\n\n\n\n<p>Children, particularly neonates and infants,&nbsp;differ significantly from adults&nbsp;in cardiovascular physiology.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Their cardiac reserve is limited due to:\n<ul class=\"wp-block-list\">\n<li>Immature myocardium<\/li>\n\n\n\n<li>Reduced compliance<\/li>\n\n\n\n<li>Greater dependency on heart rate to maintain cardiac output<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Traditional vital signs are often poor surrogates for perfusion status:\n<ul class=\"wp-block-list\">\n<li>Normal blood pressure does not guarantee adequate CO or tissue oxygenation<\/li>\n\n\n\n<li>Tachycardia may reflect pain, fever, or stress rather than hypovolemia, only to name a few<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>Consequently,&nbsp;advanced haemodynamic monitoring&nbsp;and&nbsp;CO assessment&nbsp;are&nbsp;invaluable tools&nbsp;in guiding&nbsp;timely&nbsp;and precise&nbsp;interventions in the&nbsp;peri-operative period&nbsp;as well as&nbsp;later on&nbsp;in the PICU.&nbsp;<\/p>\n\n\n\n<p>Strong reasons&nbsp;why&nbsp;extended&nbsp;cardiovascular monitoring&nbsp;including CO&nbsp;is&nbsp;recommended&nbsp;are:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Direct assessment of systemic perfusion&nbsp;<\/li>\n\n\n\n<li>Early detection of circulatory instability before overt clinical signs appear&nbsp;<\/li>\n\n\n\n<li>Quantitative guidance for fluid therapy and\/or vasoactive medication&nbsp;<\/li>\n\n\n\n<li>Evaluation of oxygen delivery&nbsp;relative&nbsp;to metabolic demand&nbsp;<\/li>\n<\/ul>\n\n\n\n<p>The&nbsp;aim is not simply to&nbsp;optimise&nbsp;numbers but rather to&nbsp;individualise haemodynamic management, to&nbsp;prevent organ dysfunction, and&nbsp;improve outcomes.&nbsp;<\/p>\n\n\n\n<p>Not every child requires extended cardiovascular monitoring.&nbsp;Extended CO monitoring is&nbsp;indicated&nbsp;in&nbsp;paediatric patients at risk&nbsp;of haemodynamic compromise, particularly when clinical assessment is insufficient or therapeutic decisions require precise data&nbsp;i.e.&nbsp;patients with significant comorbidities and\/or patients undergoing major surgery&nbsp;where&nbsp;blood loss is possible or major haemodynamic instability could happen.<\/p>\n\n\n\n<p>The following group of&nbsp;patients benefit from advanced haemodynamic monitoring:&nbsp;children suffering from congenital or&nbsp;acquired&nbsp;heart disease,&nbsp;septic shock or distributive shock,&nbsp;severe dehydration with ongoing fluid&nbsp;losses,&nbsp;patients&nbsp;with pulmonary&nbsp;hypertension, organ failure or multiorgan dysfunction, persistent&nbsp;hypotension or unexplained metabolic acidosis&nbsp;or&nbsp;undergoing major surgery.&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Advanced Haemodynamic Monitoring is Highly Valuable in Children With:<\/h4>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"697\" height=\"422\" src=\"http:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture1-e1764584487298.jpg\" alt=\"\" class=\"wp-image-52344\" style=\"width:634px;height:auto\" srcset=\"http:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture1-e1764584487298.jpg 697w, http:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture1-e1764584487298-480x270.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) 697px, 100vw\" \/><\/figure>\n\n\n\n<p>Peri-operatively, cardiac output monitoring helps to&nbsp;optimise&nbsp;preload and&nbsp;afterload&nbsp;and&nbsp;detect haemodynamic deterioration&nbsp;at an early stage.&nbsp;&nbsp;<\/p>\n\n\n\n<p>In the PICU, it supports&nbsp;tailored management of critically ill children&nbsp;with dynamic physiological changes. Particularly, neonates and infants benefit due to unstable physiology, narrow safety margins, and high vulnerability to fluid overload, especially in conditions like necrotising enterocolitis or diaphragmatic hernia repair.&nbsp;<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\" \/>\n\n\n\n<h2 class=\"wp-block-heading\">Methods To Measure Cardiac Output<\/h2>\n\n\n\n<p>There are several methods to measure cardiac output.&nbsp;&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"698\" height=\"421\" src=\"https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture2.jpg\" alt=\"\" class=\"wp-image-52345\" style=\"width:985px;height:auto\" srcset=\"https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture2.jpg 698w, https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture2-480x290.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) 698px, 100vw\" \/><\/figure>\n\n\n\n<p>Looking specifically at newborns,&nbsp;infants&nbsp;and&nbsp;children,&nbsp;most of the&nbsp;practitioners&nbsp;are looking for&nbsp;less or non-invasive&nbsp;methods not to induce&nbsp;additional&nbsp;harm while using invasive methods or&nbsp;additional&nbsp;central catheters in those vulnerable patients.&nbsp;&nbsp;<\/p>\n\n\n\n<p>Therefore,&nbsp;Pulse&nbsp;Contour&nbsp;Analysis&nbsp;methods&nbsp;like the&nbsp;PRAM&nbsp;(Pressure Recording Analytical Method) are&nbsp;highly interesting&nbsp;in this patient cohort. PRAM is a&nbsp;non-calibrated,&nbsp;beat-to-beat&nbsp;haemodynamic monitoring technique used to estimate cardiac output (CO) and other advanced haemodynamic parameters. The method uses the relationship between pressure variations and volume changes in the arterial system, integrating waveform shape, amplitude, and frequency content. It belongs to the family of pulse contour analysis technologies, but with a key difference.<\/p>\n\n\n\n<p>PRAM does not require external calibration&nbsp;(e.g., thermodilution), making it&nbsp;extremely useful in paediatrics&nbsp;where invasive calibration methods are often limited. PRAM&nbsp;requires&nbsp;only an arterial line&nbsp;(i.e.&nbsp;radial or femoral) which is&nbsp;routinely placed&nbsp;in&nbsp;critically&nbsp;ill children or before major surgery. Unlike other arterial waveform&nbsp;systems&nbsp;PRAM is&nbsp;totally independent&nbsp;from any algorithm calibration with pre-estimated patient data or empirical constants. Its technology, based on the perturbation theory,&nbsp;allows&nbsp;clinicians to assess in real-time what is&nbsp;happening&nbsp;to the patient in that exact moment, taking information only from its arterial blood pressure waveform.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"698\" height=\"698\" src=\"https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture3.png\" alt=\"\" class=\"wp-image-52346\" style=\"width:944px;height:auto\" srcset=\"https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture3.png 698w, https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture3-480x480.png 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) 698px, 100vw\" \/><\/figure>\n\n\n\n<p>Despite the need for reliable arterial access and high-quality waveforms, it&nbsp;remains&nbsp;a highly attractive&nbsp;option&nbsp;in paediatrics, where minimising invasive techniques is crucial.&nbsp;<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\" \/>\n\n\n\n<h2 class=\"wp-block-heading\">About the Author<\/h2>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2025\/11\/Picture4.jpg\" alt=\"\" class=\"wp-image-52347\" style=\"width:219px;height:auto\" \/><\/figure>\n\n\n\n<p><a href=\"https:\/\/campusvygon.com\/global\/author\/schindler\/\">Prof. Ehrenfried SCHINDLER<\/a><\/p>\n\n\n\n<p>Prof. Ehrenfried Schindler was elected to become the first Professor for&nbsp;Paediatric Anaesthesia in Germany on October 2019 at the University of&nbsp;Bonn. Before, he was head of the department for paediatric anaesthesia and later medical director at the Children\u2019s Hospital of Sankt Augustin in Germany for 17 years. Prof. Schindlers main interest is care for critically ill children. His research focus on anaesthesia for children with congenital heart defects and the peri-operative setting. Additionally, he was one of the pioneers in introducing ERAS (enhanced recovery after surgery) strategies and ultra-fast track anaesthesia after operations with cardiopulmonary bypass in Germany. Besides that, he was hon. Treasurer and later President of the European Society for Paediatric Anaesthesiology (ESPA). Moreover, he is a well-known lecturer at scientific meetings in Europe and serving as Associate Editor for \u201cPaediatric Anaesthesia\u201d and of Springer\u2019s Journal \u201cIntensive Care Medicine \u2013 paediatric and neonatal\u201d.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\" \/>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n<p>Alonso\u2010I\u00f1igo&nbsp;J. M.,&nbsp;Escrib\u00e1&nbsp;F. J.,&nbsp;Carrasco&nbsp;J. I.,&nbsp;Fas&nbsp;M. J.,&nbsp;Argente&nbsp;P., Galvis&nbsp;J. M., &amp; Llopis&nbsp;J. E. (2016).&nbsp;Measuring cardiac output in children undergoing cardiac&nbsp;catheterization :&nbsp;comparison between the Fick method and PRAM (pressure recording analytical method).&nbsp;<em>Paediatric&nbsp;Anaesthesia<\/em>,&nbsp;<em>26<\/em>(11), 10971105. https:\/\/doi.org\/10.1111\/pan.12997&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Prof. Ehrenfried SCHINDLER PRAM and MostCare are trademarks of Bio-Si International s.r.l. Haemodynamic monitoring is essential in paediatric peri-operative and critical care medicine,&nbsp;guiding adequate tissue perfusion and oxygen delivery&nbsp;in the most vulnerable patients. Although basic parameters in paediatric anaesthesia such as heart rate, blood pressure, and pulse&nbsp;oximetry play an essential role in routine peri-operative [&hellip;]<\/p>\n","protected":false},"author":141,"featured_media":52343,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[16],"tags":[60,36],"class_list":["post-52342","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anaesthesia-and-intensive-care","tag-haemodynamic-monitoring","tag-p-r-a-m-method"],"acf":[],"_links":{"self":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/52342","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/users\/141"}],"replies":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/comments?post=52342"}],"version-history":[{"count":8,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/52342\/revisions"}],"predecessor-version":[{"id":52865,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/52342\/revisions\/52865"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/media\/52343"}],"wp:attachment":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/media?parent=52342"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/categories?post=52342"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/tags?post=52342"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}