Hemodynamic Monitoring and Support

Vincent, Jean‐Louis; Joosten, Alexandre; Saugel, Bernd

doi:10.1097/ccm.0000000000005213

Cited by 18 publications

(11 citation statements)

References 97 publications

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“…This can be a result of the sparse use of invasive tools for hemodynamic monitoring, such as central venous pressure or pulmonary artery catheters, in children as compared to adults. Therefore, in contrast to the adult ICU, fluid resuscitation is not always performed based upon valid parameters and might contribute to fluid overload ( 23 , 24 ). Future research needs to identify more accurate parameters for guiding fluid resuscitation in critically ill children in order to prevent fluid overload.…”

Section: Discussionmentioning

confidence: 99%

“…55/86 (63.9%) of the respondents reported that they use the Holiday-Segar formula (4 ml/kg/h for the first 10 kg + 2 ml/kg/u for the second 10 kg + 1 ml/kg/u>20 kg) to determine the normal daily total fluid volume requirement in healthy children (non-critically ill, non-mechanically ventilated patients). For PICU patients at the start of invasive mechanical ventilation, 64/86 (74.4%) of the respondents reported to give less fluids (median (IQR) 20% (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)] based on the calculated normal daily total fluid volume. The remainder of the respondents 21/86 (24.4 %) stated to give the full 100% of calculated normal maintenance fluid.…”

Section: Determining Total Fluid Maintenance Requirementmentioning

confidence: 99%

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Current Practice of Fluid Maintenance and Replacement Therapy in Mechanically Ventilated Critically Ill Children: A European Survey

et al. 2022

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Appropriate fluid management in mechanically ventilated critically ill children remains an important challenge and topic of active discussion in pediatric intensive care medicine. An increasing number of studies show an association between a positive fluid balance or fluid overload and adverse outcomes. However, to date, no international consensus regarding fluid management or removal strategies exists. The aim of this study was to obtain more insight into the current clinical practice of fluid therapy in mechanically ventilated critically ill children. On behalf of the section of cardiovascular dynamics of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) we conducted an anonymous survey among pediatric intensive care unit (PICU) specialists in Europe regarding fluid overload and management. A total of 107 study participants responded to the survey. The vast majority of respondents considers fluid overload to be a common phenomenon in mechanically ventilated children and believes this complication is associated with adverse outcomes, such as mortality and duration of respiratory support. Yet, only 75% of the respondents administers a lower volume of fluids (reduction of 20% of normal intake) to mechanically ventilated critically ill children on admission. During PICU stay, a cumulative fluid balance of more than 5% is considered to be an indication to reduce fluid intake and start diuretic treatment in most respondents. Next to fluid balance calculation, the occurrence of peripheral and/or pulmonary edema (as assessed including by chest radiograph and lung ultrasound) was considered an important clinical sign of fluid overload entailing further therapeutic action. In conclusion, fluid overload in mechanically ventilated critically ill children is considered an important problem among PICU specialists, but there is great heterogeneity in the current clinical practice to avoid this complication. We identify a great need for further prospective and randomized investigation of the effects of (restrictive) fluid strategies in the PICU.

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Section: Discussionmentioning

confidence: 99%

Section: Determining Total Fluid Maintenance Requirementmentioning

confidence: 99%

Current Practice of Fluid Maintenance and Replacement Therapy in Mechanically Ventilated Critically Ill Children: A European Survey

et al. 2022

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“…The use of POCUS checklists may also be considered [29]. For haemodynamic diagnosis and monitoring, numerous invasive and non‐invasive tools are in widespread use across ICUs [30, 31]. However, each carries risks of misinterpretation, even simple technologies such as direct arterial pressure monitoring [32], which can be largely circumvented by good education and awareness.…”

Section: Diagnostic Processmentioning

confidence: 99%

Difficult diagnosis in the ICU: making the right call but beware uncertainty and bias

et al. 2023

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Dealing with an uncertain or missed diagnosis is commonplace in the intensive care unit setting. Affected patients are subject to a potential decrease in quality of care and a greater risk of a poor outcome. The diagnostic process is a complex task that starts with information gathering, followed by integration and interpretation of data, hypothesis generation and, finally, confirmation of a (hopefully correct) diagnosis. This may be particularly challenging in the patient who is critically ill where a good history may not be forthcoming and/or clinical, laboratory and imaging features are non-specific. The aim of this narrative review is to analyse and describe common causes of diagnostic error in the intensive care unit, highlighting the multiple types of cognitive bias, and to suggest a diagnostic framework. To inform this review, we performed a literature search to identify relevant articles, particularly those pertinent to unclear diagnoses in patients who are critically ill. Clinicians should be cognisant as to how they formulate diagnoses and utilise debiasing strategies. Multidisciplinary teamwork and more time spent with the patient, supported by effective and efficient use of electronic healthcare records and decision support resources, is likely to improve the quality of the diagnostic process, patient care and outcomes.

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“…Hemodynamic monitoring and interventions in the intensive care unit (ICU) aim to ensure adequate circulatory function, and thus organ perfusion, through managing cardiac output and systemic vascular resistance [1] , [2] , [3] , [4] . Typically, several hemodynamic variables are continuously monitored in the ICU, primarily arterial and venous blood pressures, [2] , [5] .…”

Section: Hardware In Contextmentioning

confidence: 99%

Low cost circulatory pressure acquisition and fluid infusion rate measurement system for clinical research

Smith¹,

Rolfe²,

Cameron³

et al. 2022

HardwareX

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Hemodynamic Monitoring and Support

Cited by 18 publications

References 97 publications

Current Practice of Fluid Maintenance and Replacement Therapy in Mechanically Ventilated Critically Ill Children: A European Survey

Current Practice of Fluid Maintenance and Replacement Therapy in Mechanically Ventilated Critically Ill Children: A European Survey

Difficult diagnosis in the ICU: making the right call but beware uncertainty and bias

Low cost circulatory pressure acquisition and fluid infusion rate measurement system for clinical research

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