Continuous noninvasive monitoring of cardiac performance and tissue perfusion in pediatric trauma patients

Purpose: The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients. Methods: Review of all patients entered into a prospective noninvasive monitoring protocol. Cardiac index (CI) was measured using a thoracic bioimpedance device and tissue perfusion was assessed by transcutaneous carbon dioxide (Ptcco₂) tension and oxygen tension indexed to the fraction of inspired oxygen (Ptco₂/Fio₂). Survival probability (SP) was continuously calculated using a stochastic analysis program. Results: There were 45 patients with a total of 953 data sets. The mean age was 11 years (range, 1-16 years) with a mean Injury Severity Score of 24 (±16). There was no difference between survivors (n = 32) and nonsurvivors (n = 13) at study entry for heart rate, blood pressure, CI, or pulse oximetry (all P > .05). However, survivors demonstrated higher Ptcco₂ (45 vs 35), higher Ptco₂/Fio₂ (236 vs 156), and higher predicted SP (89% vs 62%) compared with nonsurvivors at study entry and throughout the monitoring period (all P < .01). For the entire data set, the strongest independent predictors of survival were Ptco₂/Fio₂ and SP. The area under the receiver operating characteristic curve for mortality prediction was 0.83 for SP and 0.71 for Ptco₂/Fio₂, compared with 0.6 for heart rate, 0.51 for blood pressure, and 0.53 for CI. Similar hemodynamic patterns were observed for all injury patterns with the exception of those with severe brain injury. Conclusions: Thoracic bioimpedance and transcutaneous monitoring give critical real-time hemodynamic and tissue perfusion data that can provide early identification of pathologic flow patterns and accurately predict survival.