Limitations of Conventional Hemodynamic Assessment in the PICU

• Dr. Ahmed (Gamal) Sherif — Paediatric Intensive Care Consultant, Cambridge University Hospitals NHS Foundation Trust; Co-Founder, Edu-PIC

Paediatrics

Traditional hemodynamic assessment combines physical examination with laboratory and venous parameters. Capillary refill time, pulse quality, and urine output remain useful bedside observations, but their variability and limited correlation with cardiac output can make interpretation challenging. Biomarkers such as serum lactate, lactate clearance, central venous pressure, and central venous oxygen saturation offer more objective measurements, yet they are not always specific to the underlying hemodynamic problem. Elevated lactate may reflect impaired clearance, inadequate preload, cardiac dysfunction, or metabolic disease, while central venous oxygen saturation can be influenced by anemia and other factors. These limitations highlight the need to interpret individual findings within the overall clinical context rather than relying on a single hemodynamic marker.