TU5.2 Lifting the LiDCO on Haemodynamic Monitoring. Which would you PiCCO?

Abstract

Aims Surgical patients in the intensive care unit (ICU) are frequently critically unwell with varied abnormal physiology1. The use of haemodynamic monitors in such cases is invaluable in permitting early intervention of complications such as multi-organ failure (MOF), yet is often overlooked1. A Trust-wide study was performed utilising guidelines outlining criteria for haemodynamic monitor instigation2. Methods We retrospectively reviewed the records of 20 surgical patients to determine whether standards were achieved. Concurrently, we conducted a survey of junior doctors in order to establish knowledge and identify areas for improvement. Results 20% of patients were new admissions with sepsis and MOF. 10% had inotropic requirements in accordance to Trust guidance. 35% required fluid bolus >2l within 12 hours of ICU stay; 40% did not and there was no documentation for 25% of patients. 85% were within the 1st 48 hours post-operatively. Only 4 patients received haemodynamic monitoring, LiDCO and PiCCO monitors being used equally. 12 responses were received from our survey of junior doctors. 66.7% were familiar with different haemodynamic monitor types. 58.3% stated they would be confident knowing when to initiate usage. 83.3% added they would be able to use these monitors independently. Only 2 individuals had read the Trust guidelines on haemodynamic monitoring. All participants stated they would benefit from teaching on this subject. Conclusions Our study showed Trust guidance for haemodynamic monitor instigation was not being adhered to optimally. Increased awareness via education programmes would be beneficial, ensuring more favourable outcomes for patients- surgical or otherwise.