Sensitivity of PVI, CI and ORI values obtained in the first hour through non-invasive monitoring methods for prognostic assessment in critically ill children admitted to Pediatric Intensive Care

Objectives: To evaluate the sensitivity of oxygenation and hemodynamic monitoring parameters obtained through non-invasive bedside monitoring at the time of admission for critically ill patients admitted to the pediatric intensive care unit (PICU) in predicting mortality and duration of intensive care admission. Materials and methods: A total of 54 patients were included in the study. Demographic data, admission diagnosis, underlying chronic diseases, if any, organ failure status at admission, method of oxygen support, duration of intensive care admission, and discharge status were recorded for each patient. The worst values within the first 24 hours after admission were used to calculate PRISM-IV, PIM-III, and PELOD-II scores. Patients who received fluid resuscitation and initiated inotropic support within the first hour were documented. ORI, PVI, and CI values were measured using the Masimo Rainbow Pulse Co-Oximeter and Baxter Starling Fluid Management System at admission and during the first hour of treatment. The relationship between ORI, PVI, CI values at admission, and mortality, as well as the duration of intensive care admission, was analyzed. Additionally, in the group that received fluid resuscitation and inotropic support, changes in CI and PVI were examined. Results: In the group with prolonged intensive care admission, the mean values of ORI and CI were significantly lower, while the mean PVI was higher. A 2.35 L/min/m² threshold value or above for CI0 predicted survival with 93.6% sensitivity and 71.4% specificity. When comparing the conditions before and after fluid resuscitation decisions in the group where the decision was made, we observed significant differences for both CI and PVI. Furthermore, when comparing the group with initiated inotropic support to the non-initiated group, the difference in ΔCI was statistically significant. Conclusions: Monitoring critically ill patients in the PICU is challenging and requires constant and close observation. Non-invasive methods offer easier, complication-free, and more comfortable monitoring than invasive procedures for maintaining hemodynamic stability, determining appropriate oxygen support, and monitoring fluid/blood replacement. These non-invasive techniques can be used as complementary tools alongside conventional methods in pediatric patients. Keywords: CI, ORI, PVI, mortality, LOSYB, fluid response