Current Use of Invasive and Noninvasive Monitors in Academic Pediatric Intensive Care Units

Abstract

To describe the current use of noninvasive monitoring compared with traditional invasive monitoring in Pediatric Critical Care Medicine (PCCM) accredited fellowship programs in the United States. A web-based survey with the primary aim of describing the utilization of noninvasive monitoring compared with invasive monitoring was distributed to PCCM program directors (PDs) at the 64 accredited fellowship training programs. Questions focused on demographics and the utilization of invasive and noninvasive monitoring for specific patient populations and disease states. Forty-two (66%) PDs responded to the survey. Capnography and near-infrared spectroscopy (NIRS) were the most commonly reported noninvasive monitoring technology. Arterial and central venous catheters were widely used. Other invasive monitoring devices were used sparingly. Despite widespread use of both invasive and noninvasive monitoring in academic pediatric critical care units across the United States, there is significant variability in the use of noninvasive monitoring compared with invasive monitoring. Further investigation is needed to define the standard of care for the use of noninvasive monitors as practitioners attempt to optimize care while minimizing risks and complications.

Keywords

invasive monitoring - noninvasive monitoring - patient safety - pediatric critical care - fellowship

Note

The study was conducted at the Duke University Medical Center.

• References

• 1 Matthay MA. Invasive hemodynamic monitoring in critically ill patients. Clin Chest Med 1983; 4 (02) 233-249
• 2 Vender JS, Franklin M. Hemodynamic assessment of the critically ill patient. Int Anesthesiol Clin 2004; 42 (01) 31-58
• 3 Laher AE, Watermeyer MJ, Buchanan SK. , et al. A review of hemodynamic monitoring techniques, methods and devices for the emergency physician. Am J Emerg Med 2017; 35 (09) 1335-1347
• 4 Thiele RH, Bartels K, Gan TJ. Cardiac output monitoring: a contemporary assessment and review. Crit Care Med 2015; 43 (01) 177-185
• 5 Al-Subu AM, Rehder KJ, Cheifetz IM, Turner DA. Non invasive monitoring in mechanically ventilated pediatric patients. Expert Rev Respir Med 2014; 8 (06) 693-702
• 6 Hoskote AU, Tume LN, Trieschmann U. , et al. A cross-sectional survey of near-infrared spectroscopy use in pediatric cardiac ICUs in the United Kingdom, Ireland, Italy, and Germany. Pediatr Crit Care Med 2016; 17 (01) 36-44
• 7 Hirsch JC, Charpie JR, Ohye RG, Gurney JG. Near infrared spectroscopy (NIRS) should not be standard of care for postoperative management. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2010; 13 (01) 51-54
• 8 Langhan M. Continuous end-tidal carbon dioxide monitoring in pediatric intensive care units. J Crit Care 2009; 24 (02) 227-230
• 9 Rosenberg DI, Moss MM. ; American College of Critical Care Medicine of the Society of Critical Care Medicine. Guidelines and levels of care for pediatric intensive care units. Crit Care Med 2004; 32 (10) 2117-2127
• 10 Cumming C, McFadzean J. A survey of the use of capnography for the confirmation of correct placement of tracheal tubes in pediatric intensive care units in the UK. Paediatr Anaesth 2005; 15 (07) 591-596
• 11 Kannan S, Manji M. Survey of use of end-tidal carbon dioxide for confirming tracheal tube placement in intensive care units in the UK. Anaesthesia 2003; 58 (05) 476-479
• 12 Coté CJ, Sui J, Anderson TA. , et al. Continuous noninvasive cardiac output in children: is this the next generation of operating room monitors? Initial experience in 402 pediatric patients. Paediatr Anaesth 2015; 25 (02) 150-159
• 13 Klipin M, Mare I, Hazelhurst S, Kramer B. The process of installing REDCap, a web based database supporting biomedical research: the first year. Appl Clin Inform 2014; 5 (04) 916-929
• 14 Rowley BD. AMA--Fellowship and Residency Electronic Interactive Database Access (AMA-FREIDA): a computerized residency selection tool. JAMA 1988; 260 (08) 1059
• 15 Loeb RG, Brecknell B, Sanderson PM. The sounds of desaturation: a survey of commercial pulse oximeter sonifications. Anesth Analg 2016; 122 (05) 1395-1403
• 16 Emeriaud G, Newth CJ. ; Pediatric Acute Lung Injury Consensus Conference Group. Monitoring of children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05) (Suppl. 01) S86-S101
• 17 de Caen AR, Berg MD, Chameides L. , et al. Part 12: Pediatric advanced life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132 (18) (Suppl. 02) S526-S542
• 18 Brazinova A, Majdan M, Leitgeb J, Trimmel H, Mauritz W. ; Austrian Working Group on Improvement of Early TBI Care. Factors that may improve outcomes of early traumatic brain injury care: prospective multicenter study in Austria. Scand J Trauma Resusc Emerg Med 2015; 23: 53
• 19 Stroud MH, Prodhan P, Moss M, Fiser R, Schexnayder S, Anand K. Enhanced monitoring improves pediatric transport outcomes: a randomized controlled trial. Pediatrics 2011; 127 (01) 42-48
• 20 Hansen G, Vallance JK. Ventilation monitoring in severe pediatric traumatic brain injury at nontrauma centers. Air Med J 2015; 34 (05) 278-282
• 21 Judge O, Ji F, Fleming N, Liu H. Current use of the pulmonary artery catheter in cardiac surgery: a survey study. J Cardiothorac Vasc Anesth 2015; 29 (01) 69-75
• 22 Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993-2004. JAMA 2007; 298 (04) 423-429
• 23 Rubenfeld GD, McNamara-Aslin E, Rubinson L. The pulmonary artery catheter, 1967-2007: rest in peace?. JAMA 2007; 298 (04) 458-461