Room temperature transpulmonary thermodilution (TPTD) with increased indicator 20 ml TPTD bolus compared with standard TPTD with 15 ml iced saline: a prospective observational study

W Huber,S Rasch,E Maendl,M Messer,C Schnappauf,T Lahmer,A Beitz,Rm Schmid,B Henschel,Ml Malbrain

doi:10.1186/cc14248

Abstract

Use of ice-cold saline is assumed to provide best accuracy of TPTD to obtain the cardiac index (CI), global end-diastolic volume (GEDVI) and extravascular lung-water (EVLWI). However, room-temperature injectate might facilitate TPTD outside the ICU. A recent study [1] showed acceptable bias and percentage error (PE) for CI-room derived from TPTD with 15 ml room temperature saline compared with CI-cold using 15 ml iced saline for TPTD. However, GEDVI-room and EVLWI-room had borderline PE values close to 30%, and the bias of GEDVI-room markedly increased with higher values of GEDVI and in case of femoral CVC. Since imprecision of TPTD-room might be reduced by a larger volume of injectate, it was the aim of our study to compare CI, GEDVI and EVLWI derived from TPDT using 20 ml room temperature injectate with standard TPTD with 15 ml iced saline.

Highlights

To assess cerebral hemodynamics in an experimental sepsis model
Healthy bowel function is an important factor when judging the advisability of early enteral nutrition in critically ill patients
Since the Surviving Sepsis Campaign (SSC) in 2002, the Health Service Ombudsman for England published recommendations for improving recognition and treatment of sepsis [2], the Royal College of Physicians issued a toolkit for the management of sepsis in the acute medical unit [3], and NHS England released a patient safety alert to support prompt recognition and treatment of sepsis [4]

Summary

Introduction

We evaluated platelet activation markers as potential predictive markers of sepsis and of mortality among four commonly encountered populations of patients admitted to ICUs. Methods Ninety-nine non-infected ICU patients were prospectively screened at day 1 (T1) and day 3 (T2) of admission after elective cardiac surgery, trauma, acute neurologic dysfunction or prolonged ventilation (>48 hours). The present study was performed with the aim of assessing whether nursing and physician staff were able to identify patients in need of critical care using only clinical judgment and to compare this with the National Early Warning Score (NEWS) Methods This was a prospective cohort study of all adult patients with a first-time admission to a medical admission unit at a 450-bed regional teaching hospital over a 3-month period in 2010.

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