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Poster presentation | Open | Published:

Change of therapeutic plan following advanced cardiopulmonary monitoring in critically ill patients: a multicenter study

Introduction

Many therapeutic decisions are made in the ICU on the basis of clinical judgment and conventional monitoring alone, although these may be inadequate for a reliable estimate of hemodynamic status. We therefore measured the effects of more advanced cardiopulmonary parameters (ACP) on major therapeutic decisions.

Methods

Cardiopulmonary assessment was done in critically ill patients from 12 European ICUs independently by one to four physicians per patient just before the use of the PiCCO monitor (Pulsion, Germany). Following cardiopulmonary evaluation and prediction of ACP (reported elsewhere), each physician suggested a therapeutic plan before and after the first set of PiCCO measurements (cardiac output, systemic vascular resistance, global end-diastolic volume, stroke volume variation, and extravascular lung water), and then self-rated the accuracy of his original therapeutic plan.

Results

A total of 257 questionnaires of 165 patients (67 females and 98 males, age ± SD 59.8 ± 16.7 (range 16–93) years) were completed by 135 residents and 122 specialists. The main reasons for using the PiCCO included unclear fluid status (109 cases), sepsis/septic shock (70 cases), respiratory failure (42 cases), cardiogenic shock (19 cases), renal failure (27 cases), other (18 cases). Changes (plan-and-not-give and no-plan-and-give) made in the pre-PiCCO therapeutic plans included: fluid, 31.8%; inotropes, 23.3%; vasoconstrictors, 23.5%; diuretics, 15% (Table 1). The 240 overall self-ratings of the original plan (scale of 1–5, [1] = not different; [5] = very different) included – [1] 33.7%, [2] 23.5%, [3] 25.9%, [4] 11.5%, [5] 5.3%. The mean self-rate was 2.3 ± 1.2, with that of residents (2.3 ± 1.3, n = 129) being similar to that of specialists (2.3 ± 1.1, n = 111), P < 0.88.

Table 1 (abstract P285)

Conclusion

The measurement of advanced cardiopulmonary parameters caused both specialists and residents to make considerable changes in therapeutic decisions that were previously made based on clinical judgment and conventional monitoring alone.

Acknowledgements

The authors of this unsupported study are members of Pulsion's medical advisory board.

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Keywords

  • Respiratory Failure
  • Clinical Judgment
  • Cardiogenic Shock
  • Systemic Vascular Resistance
  • Therapeutic Decision