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Haemodynamic monitoring in the intensive care unit: results from a web-based Swiss survey.

Siegenthaler N, Giraud R, Saxer T, Courvoisier DS, Romand JA, Bendjelid K - Biomed Res Int (2014)

Bottom Line: TPTD and PAC were frequently both available, although TPTD was the preferred technique.In most Swiss ICUs, multiple haemodynamic monitoring devices are available, although TPTD is most commonly used.Despite the usefulness of echocardiography and its large availability, it is not widely performed by Swiss intensivists themselves.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland ; Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.

ABSTRACT

Background: The aim of this survey was to describe, in a situation of growing availability of monitoring devices and parameters, the practices in haemodynamic monitoring at the bedside.

Methods: We conducted a Web-based survey in Swiss adult ICUs (2009-2010). The questionnaire explored the kind of monitoring used and how the fluid management was addressed.

Results: Our survey included 71% of Swiss ICUs. Echocardiography (95%), pulmonary artery catheter (PAC: 85%), and transpulmonary thermodilution (TPTD) (82%) were the most commonly used. TPTD and PAC were frequently both available, although TPTD was the preferred technique. Echocardiography was widely available (95%) but seems to be rarely performed by intensivists themselves. Guidelines for the management of fluid infusion were available in 45% of ICUs. For the prediction of fluid responsiveness, intensivists rely preferentially on dynamic indices or echocardiographic parameters, but static parameters, such as central venous pressure or pulmonary artery occlusion pressure, were still used.

Conclusions: In most Swiss ICUs, multiple haemodynamic monitoring devices are available, although TPTD is most commonly used. Despite the usefulness of echocardiography and its large availability, it is not widely performed by Swiss intensivists themselves. Regarding fluid management, several parameters are used without a clear consensus for the optimal method.

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Related in: MedlinePlus

Evaluation of various devices by intensivists according to the clinical situation. Devices were rated on a scale from 1 “worst” to 5 “best.” TPTD: transpulmonary thermodilution, PAC: pulmonary artery catheter.
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fig3: Evaluation of various devices by intensivists according to the clinical situation. Devices were rated on a scale from 1 “worst” to 5 “best.” TPTD: transpulmonary thermodilution, PAC: pulmonary artery catheter.

Mentions: The method considered optimal for haemodynamic monitoring varied according to the clinical situation (Figure 3). During cardiogenic shock, Swiss intensivists considered monitoring with PAC or echocardiography equally good and reported these two monitoring techniques superior to other techniques. During septic shock, intensivists considered TPTD to be the most appropriate monitoring technique. Finally, during acute respiratory distress syndrome (ARDS), intensivists considered TPTD and PAC to be the best techniques; interestingly, these two techniques were considered to be equivalent in this situation.


Haemodynamic monitoring in the intensive care unit: results from a web-based Swiss survey.

Siegenthaler N, Giraud R, Saxer T, Courvoisier DS, Romand JA, Bendjelid K - Biomed Res Int (2014)

Evaluation of various devices by intensivists according to the clinical situation. Devices were rated on a scale from 1 “worst” to 5 “best.” TPTD: transpulmonary thermodilution, PAC: pulmonary artery catheter.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016935&req=5

fig3: Evaluation of various devices by intensivists according to the clinical situation. Devices were rated on a scale from 1 “worst” to 5 “best.” TPTD: transpulmonary thermodilution, PAC: pulmonary artery catheter.
Mentions: The method considered optimal for haemodynamic monitoring varied according to the clinical situation (Figure 3). During cardiogenic shock, Swiss intensivists considered monitoring with PAC or echocardiography equally good and reported these two monitoring techniques superior to other techniques. During septic shock, intensivists considered TPTD to be the most appropriate monitoring technique. Finally, during acute respiratory distress syndrome (ARDS), intensivists considered TPTD and PAC to be the best techniques; interestingly, these two techniques were considered to be equivalent in this situation.

Bottom Line: TPTD and PAC were frequently both available, although TPTD was the preferred technique.In most Swiss ICUs, multiple haemodynamic monitoring devices are available, although TPTD is most commonly used.Despite the usefulness of echocardiography and its large availability, it is not widely performed by Swiss intensivists themselves.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland ; Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.

ABSTRACT

Background: The aim of this survey was to describe, in a situation of growing availability of monitoring devices and parameters, the practices in haemodynamic monitoring at the bedside.

Methods: We conducted a Web-based survey in Swiss adult ICUs (2009-2010). The questionnaire explored the kind of monitoring used and how the fluid management was addressed.

Results: Our survey included 71% of Swiss ICUs. Echocardiography (95%), pulmonary artery catheter (PAC: 85%), and transpulmonary thermodilution (TPTD) (82%) were the most commonly used. TPTD and PAC were frequently both available, although TPTD was the preferred technique. Echocardiography was widely available (95%) but seems to be rarely performed by intensivists themselves. Guidelines for the management of fluid infusion were available in 45% of ICUs. For the prediction of fluid responsiveness, intensivists rely preferentially on dynamic indices or echocardiographic parameters, but static parameters, such as central venous pressure or pulmonary artery occlusion pressure, were still used.

Conclusions: In most Swiss ICUs, multiple haemodynamic monitoring devices are available, although TPTD is most commonly used. Despite the usefulness of echocardiography and its large availability, it is not widely performed by Swiss intensivists themselves. Regarding fluid management, several parameters are used without a clear consensus for the optimal method.

Show MeSH
Related in: MedlinePlus