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Practice of hemodynamic monitoring and management in German, Austrian, and Swiss intensive care units : the multicenter cross-sectional ICU-CardioMan Study

  • Background: Hemodynamic instability is frequent and outcome-relevant in critical illness. The understanding of complex hemodynamic disturbances and their monitoring and management plays an important role in treatment of intensive care patients. An increasing number of treatment recommendations and guidelines in intensive care medicine emphasize hemodynamic goals, which go beyond the measurement of blood pressures. Yet, it is not known to which extent the infrastructural prerequisites for extended hemodynamic monitoring are given in intensive care units (ICUs) and how hemodynamic management is performed in clinical practice. Further, it is still unclear which factors trigger the use of extended hemodynamic monitoring. Methods: In this multicenter, 1-day (November 7, 2013, and the preceding 24 h) cross-sectional study, we retrieved data on patient monitoring from ICUs in Germany, Austria, and Switzerland by means of a web-based case report form. One hundred and sixty-one intensive care units contributed detailed information on availability of hemodynamic monitoring. In addition, detailed information on hemodynamic monitoring of 1789 patients that were treated on due date was collected, and independent factors triggering the use of extended hemodynamic monitoring were identified by multivariate analysis. Results: Besides basic monitoring with electrocardiography (ECG), pulse oximetry, and blood pressure monitoring, the majority of patients received invasive arterial (77.9 %) and central venous catheterization (55.2 %). All over, additional extended hemodynamic monitoring for assessment of cardiac output was only performed in 12.3 % of patients, while echocardiographic examination was used in only 1.9 %. The strongest independent predictors for the use of extended hemodynamic monitoring of any kind were mechanical ventilation, the need for catecholamine therapy, and treatment backed by protocols. In 71.6 % of patients in whom extended hemodynamic monitoring was added during the study period, this extension led to changes in treatment. Conclusions: Extended hemodynamic monitoring, which goes beyond the measurement of blood pressures, to date plays a minor role in the surveillance of critically ill patients in German, Austrian, and Swiss ICUs. This includes also consensus-based recommended diagnostic and monitoring applications, such as echocardiography and cardiac output monitoring. Mechanical ventilation, the use of catecholamines, and treatment backed by protocol could be identified as factors independently associated with higher use of extended hemodynamic monitoring.
Metadaten
Author:Sandra Funcke, Michael Sander, Matthias Göpfert, Heinrich Volker Groesdonk, Matthias Heringlake, Jan Hirsch, Stefan KlugeORCiDGND, Claus Krenn, Marco Maggiorini, Patrick MeybohmORCiDGND, Cornelie Salzwedel, Bernd Saugel, Gudrun Wagenpfeil, Stefan Wagenpfeil, Daniel A. Reuter
URN:urn:nbn:de:hebis:30:3-457662
DOI:https://doi.org/10.1186/s13613-016-0148-2
ISSN:2110-5820
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/27246463
Parent Title (English):Annals of intensive care
Publisher:Springer
Place of publication:Heidelberg
Document Type:Article
Language:English
Year of Completion:2016
Date of first Publication:2016/05/31
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Contributing Corporation:ICU-CardioMan Investigators
Release Date:2018/03/01
Tag:Cardiac output; Echocardiography; Guidelines; Hemodynamic management; Pulse contour analysis; Pulse pressure variation; Stroke volume variation; Thermodilution; Treatment protocol
Volume:6
Issue:1, Art. 49
Page Number:10
First Page:1
Last Page:10
Note:
Erratum erschienen in Annals of intensive care, 7.2017, Nr. 1, Art. 75, doi:10.1186/s13613-017-0297-y
Note:
Open Access: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
HeBIS-PPN:431520887
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 4.0