**5.7. Paediatrics**

algorithms currently being used to convert pressure to blood flow are still in need of improve‐ ment. The most successful pulse contour system in use in the intensive care setting is the PiCCO plus (Pulsion) that integrates transpulmonary thermodilution readings with femoral artery pulse contour readings. The PiCCO system can be upgraded to measure blood volume, liver blood flow and mixed venous saturation. The FloTrac-Vigileo system (Edwards Lifesciences) also been upgraded from just monitoring cardiac output to a more global approach in their

Functional haemodynamic monitoring has also become popular using arterial trace based parameters such as stroke volume (SVV) and pulse pressure (PPV) variation to guide

When MICOM is used in high dependency areas for patient monitoring continuous noninva‐ sive systems are required. Pulse contour systems can be used providing the patient has an arterial line. The noninvasive nature of bioreactance (NICOM) makes it a potentially useful

MICOM has two potential roles in accident and emergency (i) to facilitate resuscitate and (ii) rapid bedside haemodynamic assessment of patients. Thus, systems that can be rapidly set up

For resuscitation both Doppler and pulse contour methods can be used, though for pulse contour monitoring an arterial line would need to be set up. Furthermore, a self calibrating system would be necessary. The development of noninvasive external, supra-sternal and precordial, Doppler (USCOM) has resulted in some novel application in the emergency medicine setting. Assessment of cardiac output in elderly patients admitted with general malaise can help identify early septic shock and may potentially reduce the number that need intensive care admission. Bedside cardiac output measurement in patients with hypertension helps one to differentiate between high peripheral resistance and high cardiac output as a cause

NICOM in medicine contribute to the haemodynamic assessment of patients by providing cardiac output and related measurements. They form part of multiple modality haemody‐ namic investigation systems, such as the Task Force Monitor (CNSystems), where they are used to assess autonomic dysfunction in diabetes and postural reflexes in patients with syncopy by head up tilting and similar tests. In cardiology they have been used to optimize pacemaker settings. MICOM devices that are noninvasive such as bioimpedance and finger

new EV1000 clinical platform monitor.

**5.4. High dependency units**

monitor in this setting.

**5.5. Accident and emergency**

and used at the bedside are ideal.

**5.6. Medicine and cardiology**

plethysmography tend to be used.

and helps in determining the most appropriate drug therapy.

therapy [34].

62 Artery Bypass

Most MICOM modalities have been adapted for use children. Noninvasive modalities like external Doppler (USCOM) has become increasingly popular in children because there is no need to insert lines. It works extremely well in small children and neonates as signal acquisition is good [35]. There is a growing interest in developing its use in paediatric intensive care for clinical situations such as rapid identification and treatment of shock [36].
