Are management decisions in critical patients changed with use of hemodynamic parameters from transpulmonary thermodilution technique?
| Autor: | Ye Rim Chang, Sung Wook Chang, Seok Ho Choi |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Cardiac output
medicine.medical_specialty Ejection fraction business.industry medicine.medical_treatment Central venous pressure Hemodynamics 030208 emergency & critical care medicine General Medicine Stroke volume 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Amputation Intensive care Emergency medicine Vascular resistance medicine Original Article business |
| Zdroj: | Annals of translational medicine. 7(16) |
| ISSN: | 2305-5839 |
| Popis: | Background: The assessment of hemodynamic variables is a mainstay in the management of critically ill patients. Hemodynamic variables may help physicians to choose among use of a vasopressor, an inotropic agent, or discontinuation of drugs. In this study, we aimed to investigate the usefulness of advanced hemodynamic variables in clinical decision-making. Methods: Surveys regarding the case were administered to 25 surgeons working in nationally designated trauma centers or on trauma teams, using a voting system at a medical conference. The patient was a 67-year-old male with a crush injury of the left leg after a pedestrian traffic accident, who had aggravated pulmonary edema after leg amputation. Three clinical situations were given and the decision choices were: immediately after amputation, in 8 hours, and on the second day after amputation. Three kinds of variables from hemodynamic monitoring systems were provided for each clinical situation: conventional hemodynamic variables, including central venous pressure; variables from pulse contour analysis (PCA) [cardiac output (CO), stroke volume index, stroke volume variation (SVV), and systemic vascular resistance index); and variables from transpulmonary thermodilution (TPTD) technique (global ejection fraction and extravascular lung water index). The changes in decisions according to each provided hemodynamic variable were investigated and analyzed. Results: The advanced hemodynamic parameters were considered to have a decisive effect on choosing vasopressors and inotropic agents. The decision was changed in 88% (22/25) of physicians using variables from the advanced monitoring systems. Among them, 82% (18/22) of physicians chose hemodynamic variables from the TPTD technique as their reason for change regarding management of a patient with severe pulmonary edema. Conclusions: Advanced monitoring systems might be helpful in decision-making for critically ill patients. Multiple parameters and trends in change could be more important than a single value. Clinicians should select the system most appropriate according to its advantages and limitations, and interpret the variables obtained correctly. |
| Databáze: | OpenAIRE |
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