| Title |
The effects of advanced monitoring on hemodynamic management in critically ill patients: a pre and post questionnaire study
|
|---|---|
| Published in |
Journal of Clinical Monitoring and Computing, December 2015
|
| DOI | 10.1007/s10877-015-9811-7 |
| Pubmed ID | |
| Authors |
Azriel Perel, Bernd Saugel, Jean-Louis Teboul, Manu L. N. G. Malbrain, Francisco Javier Belda, Enrique Fernández-Mondéjar, Mikhail Kirov, Julia Wendon, Roger Lussmann, Marco Maggiorini |
| Abstract |
In critically ill patients, many decisions depend on accurate assessment of the hemodynamic status. We evaluated the accuracy of physicians' conventional hemodynamic assessment and the impact that additional advanced monitoring had on therapeutic decisions. Physicians from seven European countries filled in a questionnaire in patients in whom advanced hemodynamic monitoring using transpulmonary thermodilution (PiCCO system; Pulsion Medical Systems SE, Feldkirchen, Germany) was going to be initialized as part of routine care. The collected information included the currently proposed therapeutic intervention(s) and a prediction of the expected transpulmonary thermodilution-derived variables. After transpulmonary thermodilution measurements, physicians recorded any changes that were eventually made in the original therapeutic plan. A total of 315 questionnaires pertaining to 206 patients were completed. The mean difference (±standard deviation; 95 % limits of agreement) between estimated and measured hemodynamic variables was -1.54 (±2.16; -5.77 to 2.69) L/min for the cardiac output (CO), -74 (±235; -536 to 387) mL/m(2) for the global end-diastolic volume index (GEDVI), and -0.5 (±5.2; -10.6 to 9.7) mL/kg for the extravascular lung water index (EVLWI). The percentage error for the CO, GEDVI, and EVLWI was 66, 64, and 95 %, respectively. In 54 % of cases physicians underestimated the actual CO by more than 20 %. The information provided by the additional advanced monitoring led 33, 22, 22, and 13 % of physicians to change their decisions about fluids, inotropes, vasoconstrictors, and diuretics, respectively. The limited clinical ability of physicians to correctly assess the hemodynamic status, and the significant impact that more physiological information has on major therapeutic decisions, support the use of advanced hemodynamic monitoring in critically ill patients. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 47 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 47 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 6 | 13% |
| Researcher | 5 | 11% |
| Student > Postgraduate | 5 | 11% |
| Student > Bachelor | 3 | 6% |
| Professor | 3 | 6% |
| Other | 10 | 21% |
| Unknown | 15 | 32% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 19 | 40% |
| Nursing and Health Professions | 4 | 9% |
| Engineering | 4 | 9% |
| Psychology | 1 | 2% |
| Sports and Recreations | 1 | 2% |
| Other | 1 | 2% |
| Unknown | 17 | 36% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 06 August 2017.
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#20,298,249
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Outputs from Journal of Clinical Monitoring and Computing
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Outputs of similar age from Journal of Clinical Monitoring and Computing
#11
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