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Purpose <p>To evaluate the accuracy and trending ability of the non-invasive esCCO (Estimated Continuous Cardiac Output, Nihon Kohden) in mechanically ventilated children.</p> Methods <p>This prospective observational study compared Ci measurements obtained using esCCO and transthoracic echocardiography (TTE). At baseline (T0), esCCO was initially calibrated using demographic data (sex, age, weight, and height) and then recalibrated based on Ci values measured by TTE. Follow-up measurements were conducted at 2&#xa0;h (T1) and 18&#xa0;h (T2) post-recalibration. Agreement was assessed using Bland-Altman analysis and Lin’s concordance correlation coefficient; trending ability was evaluated with a four-quadrant plot.</p> Results <p>Fifty patients were included, with a median age of 7.5 months (IQR: 3–54 months). At T0, esCCO showed poor agreement with TTE, with a bias of + 5.9&#xa0;L·min⁻¹·m⁻² and wide limits of agreement (− 1.2 to + 13.1&#xa0;L·min⁻¹·m⁻²), resulting in a percentage error of 106.9%. After calibration with TTE, agreement improved significantly: at T1, the bias was + 0.1&#xa0;L·min⁻¹·m⁻² with limits of agreement from − 1.0 to + 1.3 and a percentage error of 12.7%; at T2, the bias was + 0.2 (− 1.7 to + 2.0) with a percentage error of 20.7%. Trend analysis showed a concordance rate of 79%, indicating moderate trending ability.</p> Conclusion <p>While esCCO demonstrated improved agreement with TTE following recalibration, its accuracy declined over time, highlighting the need for periodic recalibration to maintain reliability. Importantly, the agreement between esCCO and TTE without calibration was not clinically acceptable, limiting its use in clinical decision-making in the absence of recalibration.</p>

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Accuracy and trending ability of non-invasive pulse-wave transit time-based cardiac output monitoring (esCCO) in critically ill children

  • 期刊论文

  • 发表日期：

    2025年6月27日

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  • Raísa Sanches Uzun,
  • Humberto Magalhães Silva,
  • Nayara Hillebrand Franzon,
  • Victoria Carneiro Lintz,
  • Isabel de Siqueira Ferraz,
  • Roberto José Negrão Nogueira,
  • Tiago Henrique De Souza

摘要

Purpose

To evaluate the accuracy and trending ability of the non-invasive esCCO (Estimated Continuous Cardiac Output, Nihon Kohden) in mechanically ventilated children.

Methods

This prospective observational study compared Ci measurements obtained using esCCO and transthoracic echocardiography (TTE). At baseline (T0), esCCO was initially calibrated using demographic data (sex, age, weight, and height) and then recalibrated based on Ci values measured by TTE. Follow-up measurements were conducted at 2 h (T1) and 18 h (T2) post-recalibration. Agreement was assessed using Bland-Altman analysis and Lin’s concordance correlation coefficient; trending ability was evaluated with a four-quadrant plot.

Results

Fifty patients were included, with a median age of 7.5 months (IQR: 3–54 months). At T0, esCCO showed poor agreement with TTE, with a bias of + 5.9 L·min⁻¹·m⁻² and wide limits of agreement (− 1.2 to + 13.1 L·min⁻¹·m⁻²), resulting in a percentage error of 106.9%. After calibration with TTE, agreement improved significantly: at T1, the bias was + 0.1 L·min⁻¹·m⁻² with limits of agreement from − 1.0 to + 1.3 and a percentage error of 12.7%; at T2, the bias was + 0.2 (− 1.7 to + 2.0) with a percentage error of 20.7%. Trend analysis showed a concordance rate of 79%, indicating moderate trending ability.

Conclusion

While esCCO demonstrated improved agreement with TTE following recalibration, its accuracy declined over time, highlighting the need for periodic recalibration to maintain reliability. Importantly, the agreement between esCCO and TTE without calibration was not clinically acceptable, limiting its use in clinical decision-making in the absence of recalibration.