Advanced hemodynamic monitoring in intensive care medicine

Saugel, Bernd; Reese, Philip C.; Wagner, Julia Y.; Buerke, Michael; Huber, Wolfgang; Kluge, Stefan; Prondzinsky, Roland

doi:10.1007/s00063-017-0302-0

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Preau et al (14) reported that dynamic parameters were often incorrectly used in the presence of contraindications in six French ICU. Those findings highlight the great variability in fluid management in critically ill patients, the gap in integrating different hemodynamic variables into management decisions, and the importance of continuing education and training of advanced HM at different levels and in different ways (13,16).…”

Section: Discussionmentioning

confidence: 97%

“…How HM is actually practiced in intensive care units (ICU) has been described by surveys in many countries including Swiss (2,7), Austrian (7,8), Italian (9,10), the United Kingdom (11), USA (12), Brazil (13), France (14,15), German (7,16) and fields (10,12,17,18). To date there is little information about practice of HM in pediatric intensive care units in China.…”

Section: Introductionmentioning

confidence: 99%

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An email-based survey of practice regarding hemodynamic monitoring and management in children with septic shock in China

Wang

Qian

et al. 2021

Transl Pediatr

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Background: Understanding current hemodynamic monitoring (HM) practice patterns is essential to determine education and training strategies in China. The survey was to describe the practice of HM and management in children with septic shock in China. Methods: We conducted an Email-based survey of members of sub-association of pediatric intensive care physicians. The questionnaire consisted of 22 questions and gathered the following information: (I) general information on the hospitals, respective ICUs and participants, (II) the availability of technical equipment and parameters of HM and (III) management simulation of septic shock in three clinical case vignettes. Results: Surveys were received from 68 institutions (87.2%) and 368 questionnaires (response-rate 45.1%) were included. Basic HM (93-100%) were reported as the most utilized parameters, followed by advanced HM which included central venous pressure (CVP) (56.0%), cardiac output (53.5%), and central venous oxygen saturation (36.7%), 61.1% (225/368) of respondents stated the utilization of non-invasive HM equipment. The factors such as ICU specialist training center (P=0.003) and more than 30 cases of septic shock per year (P=0.002) were related to the utilization of non-invasive monitoring equipment. In the simulated case vignette, 49.7% (183/368) of respondents reported performing fluid responsiveness and volume status (FR-VS) assessment. Despite differences in training centers (P=0.005) and educational backgrounds (P=0.030), FR-VS assessment was not related to the volume expansion decision. Conclusions: There is a large variability in use advanced HM parameters, an increasing awareness and acceptance of non-invasive HM devices and a potential need for hemodynamic education and training in pediatric intensive care medicine in China.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

An email-based survey of practice regarding hemodynamic monitoring and management in children with septic shock in China

Wang

Qian

et al. 2021

Transl Pediatr

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“…In order to do this, a comparison with a thermodilution method will have to be performed. We chose CCUS as reference because it is currently the first-line evaluation modality in patients with circulatory shock and also because it is widely available and used in the ICU for diagnostic purposes [2, 29]. However, images required to make CO CCUS measurements are unobtainable in up to 20% of patients [30].…”

Section: Discussionmentioning

confidence: 99%

Disagreement in cardiac output measurements between fourth-generation FloTrac and critical care ultrasonography in patients with circulatory shock: a prospective observational study

et al. 2019

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Background Cardiac output measurements may inform diagnosis and provide guidance of therapeutic interventions in patients with hemodynamic instability. The FloTrac™ algorithm uses uncalibrated arterial pressure waveform analysis to estimate cardiac output. Recently, a new version of the algorithm has been developed. The aim was to assess the agreement between FloTrac™ and routinely performed cardiac output measurements obtained by critical care ultrasonography in patients with circulatory shock. Methods A prospective observational study was performed in a tertiary hospital from June 2016 to January 2017. Adult critically ill patients with circulatory shock were eligible for inclusion. Cardiac output was measured simultaneously using FloTrac™ with a fourth-generation algorithm (CO AP ) and critical care ultrasonography (CO CCUS ). The strength of linear correlation of both methods was determined by the Pearson coefficient. Bland-Altman plot and four-quadrant plot were used to track agreement and trending ability. Result Eighty-nine paired cardiac output measurements were performed in 17 patients during their first 24 h of admittance. CO AP and CO CCUS had strong positive linear correlation ( r 2 = 0.60, p < 0.001). Bias of CO AP and CO CCUS was 0.2 L min −1 (95% CI − 0.2 to 0.6) with limits of agreement of − 3.6 L min −1 (95% CI − 4.3 to − 2.9) to 4.0 L min −1 (95% CI 3.3 to 4.7). The percentage error was 65.6% (95% CI 53.2 to 77.3). Concordance rate was 64.4%. Conclusions In critically ill patients with circulatory shock, there was disagreement and clinically unacceptable trending ability between values of cardiac output obtained by uncalibrated arterial pressure waveform analysis and critical care ultrasonography. Trial registration Clinicaltrials.gov, NCT02912624 , registered on September 23, 2016 Electronic supplementary material The online version of this article (10.1186/s40560-019-0373-5) contains supplementary material, which is available to authorized users.

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“…Determination of blood flow through invasive techniques is an integral part of advanced hemodynamic monitoring in adult intensive care and perioperative medicine ( 23 ). NICOM is an emerging tool that allows for a continuous assessment of cardiac output.…”

Section: A Comprehensive Neonatal Hemodynamic Monitoring Modelmentioning

confidence: 99%

Monitoring Circulation During Transition in Extreme Low Gestational Age Newborns: What’s on the Horizon?

et al. 2018

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Echocardiography and near-infrared spectroscopy have significantly changed our view on hemodynamic transition of the extreme preterm infant. Instead of focusing on maintaining an arbitrary target value of blood pressure, we aim for circulatory well-being by a comprehensive holistic assessment of markers of cardiovascular instability. Most of these clinical and biochemical indices are influenced by transition itself and remain poor discriminators to identify patients with a potential need for therapeutic intervention. At the same time, the evolution in data capturing and storage has led to a change in our approach to monitor vital parameters. Continuous trend monitoring has become more and more relevant. By using signal extraction methods, changes in trends over time can be quantified. In this review, we will discuss the impact of these innovations on the current monitoring practices and explore some of the potential benefits these techniques may have in improving real-time detection of extreme low birth weight infants at risk for morbidity related to impaired hemodynamic transition.

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Advanced hemodynamic monitoring in intensive care medicine

Abstract: This survey study shows that German intensivists deem advanced hemodynamic assessment necessary for the differential diagnosis of circulatory shock and to guide therapy with fluids, vasopressors, and inotropes in ICU patients.

Cited by 6 publications

References 24 publications

An email-based survey of practice regarding hemodynamic monitoring and management in children with septic shock in China

An email-based survey of practice regarding hemodynamic monitoring and management in children with septic shock in China

Disagreement in cardiac output measurements between fourth-generation FloTrac and critical care ultrasonography in patients with circulatory shock: a prospective observational study

Monitoring Circulation During Transition in Extreme Low Gestational Age Newborns: What’s on the Horizon?

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