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The Quest for the Holy Grail of Optimizing Mechanical Ventilation and Protecting the Lung in Mechanically Ventilated Infants and Children.

Pediatric Critical Care Medicine www.pccmjournal.org 1075 Furthermore, an even more complex question that is not limited to transport is how to appropriately validate these noninvasive hemodynamic monitors and how to establish the clinical significance of the values obtained. Interestingly, the study by Boet et al (9) also exemplifies how limited interpretation of noninvasive hemodynamic monitoring data can be. Although both EC and ultrasound were not affected by transport and showed a good correlation between them, SV measured by EC was consistently higher than values from obtained ultrasound even though EC has been reported to be biased to underestimate CI (10). Although difficult to interpret in a population of hemodynamically stable patients, these differences could be clinically significant in an unstable population. There is a long road ahead for hemodynamic monitoring during pediatric transport, but the article by Boet et al (9) has provided an essential first step into this journey.