Abstract
Background: Maintenance of normal fluid homeostasis is challenging in neurosurgical patients. Consequently, we studied hydration assessment in neurosurgical intensive care patients. Methods: Pulmonary artery catheter thermodilution (PACTD) is the conventional method for measuring cardiac index (CI) and mean pulmonary artery occlusion (MPAOP) or wedge pressure (MPWP). We compared values from this technique with those derived from continuous cardiac dynamic monitoring (CCDM)-HeartSmart?, a new, less invasive, software-based technique. Over 4 years, we undertook an audit of 101 paired sets of data from 21 patients with sub-arachnoid hemorrhage who had pulmonary artery flotation catheters inserted as part of their treatment. Measured values of CI and MPWP were obtained retrospectively from patients’ charts and compared with values calculated using CCDM-HeartSmart? software. Results: Using the Bland-Altman method for comparing two measurement techniques, there was good agreement between measured and calculated MPWP (mean of differences –1.81, SD 3.97, SE 0.39, 95% CI –2.59 to 2.04 l/min/m2; two-sided p 2). This indicates that, when estimating CI and MPWP in critically ill neurosurgical patients, CCDM-HeartSmart? provides values close to those generated using PACTD. Conclusions: The CCDM-HeartSmart? could prove invaluable for optimizing response to fluid replacement and for guiding cardiovascular support in neurosurgical patients. This new, simple technology may help to facilitate routine adoption of perioperative optimization of blood flow using early goal-directed therapy.
Highlights
Treating neurological patients is a challenge, especially as many secondary pathological complications soon set in, necessitating extensive observations and treatment
Fluid resuscitation with early goal-directed therapy and monitoring of blood lactate and glucose levels is one of the many treatments necessary. This treatment requires the use of hemodynamic monitoring and maintenance of normal fluid homeostasis, which is beneficial for improving the chances of survival and averting permanent disability when treating any of the many complications that can arise after the initial insult
We have investigated new bedside monitoring software known as continuous cardiac dynamic monitoring (CCDM)-HeartSmart® (HeartSmart Limited, Harlow, Essex, UK), which helps the clinician to assess hydration by calculating cardiac output (CO) and left-heart response to fluids and inotropes
Summary
Treating neurological patients is a challenge, especially as many secondary pathological complications soon set in, necessitating extensive observations and treatment. Fluid resuscitation with early goal-directed therapy and monitoring of blood lactate and glucose levels is one of the many treatments necessary This treatment requires the use of hemodynamic monitoring and maintenance of normal fluid homeostasis, which is beneficial for improving the chances of survival and averting permanent disability when treating any of the many complications that can arise after the initial insult. The measured and calculated values of CI were in good agreement (mean of differences 0.36, SD 1.30, SE 0.13, 95% CI 0.109 - 0.619; two-sided p = 0.0055, 95% limits of agreement –2.1 to 2.91 l/min/m2) This indicates that, when estimating CI and MPWP in critically ill neurosurgical patients, CCDM-HeartSmart® provides values close to those generated using PACTD. Conclusions: The CCDM-HeartSmart® could prove invaluable for optimizing response to fluid replacement and for guiding cardiovascular support in neurosurgical patients This new, simple technology may help to facilitate routine adoption of perioperative optimization of blood flow using early goal-directed therapy
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
