Haemodynamic Monitoring in the Intensive Care Unit: Results from a Web-Based Swiss Survey

Abstract

Background. The aim of this survey was to describe, in a situation of growing availability of monitoring devices and parameters, the practices in haemodynamic monitoring at the bedside. Methods. We conducted a Web-based survey in Swiss adult ICUs (2009-2010). The questionnaire explored the kind of monitoring used and how the fluid management was addressed. Results. Our survey included 71% of Swiss ICUs. Echocardiography (95%), pulmonary artery catheter (PAC: 85%), and transpulmonary thermodilution (TPTD) (82%) were the most commonly used. TPTD and PAC were frequently both available, although TPTD was the preferred technique. Echocardiography was widely available (95%) but seems to be rarely performed by intensivists themselves. Guidelines for the management of fluid infusion were available in 45% of ICUs. For the prediction of fluid responsiveness, intensivists rely preferentially on dynamic indices or echocardiographic parameters, but static parameters, such as central venous pressure or pulmonary artery occlusion pressure, were still used. Conclusions. In most Swiss ICUs, multiple haemodynamic monitoring devices are available, although TPTD is most commonly used. Despite the usefulness of echocardiography and its large availability, it is not widely performed by Swiss intensivists themselves. Regarding fluid management, several parameters are used without a clear consensus for the optimal method.

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

“…Our data show that technical requirements for basic hemodynamic monitoring, i.e., ECG, noninvasive blood pressure monitoring, and pulse oximetry, were given on all units. Noninvasive, extended hemodynamic monitoring (finger plethysmography waveform analysis, continuous blood pressure monitoring by volume clamp methods, or esophageal Doppler) was only available in very few of the studied ICUs, which is in line with earlier data from Switzerland [ 12 ]. Of note, there was obviously no relevant difference between the unit-leading disciplines regarding availability of these noninvasive technologies.…”

“…But how this has influenced practice of hemodynamic monitoring and management in reality has only scarcely been investigated. Data regarding availability of monitoring equipment based on smaller surveys were published earlier from Switzerland including 55 medical and surgical ICUs, from Germany in 55 cardiac surgery ICUs, as well as from Italy again in 71 cardiac surgery centers [ 12 – 14 ]. Strength of our data set is that it represents data from a broad spectrum of ICUs of different sizes and a balanced proportion of ICUs at both university hospitals and non-university hospitals.…”

Central Venous Pressure as a Predictor of Fluid Responsiveness: Is This All You Need?

“…Similar findings have been reported in a consistent number of studies performed in different parts of the world in both adult and pediatric patients [7][8][9]. Although practice might be changing, particularly in the general ICU setting [10], it seems that there is still a relevant gap between research and everyday clinical practice. This might be due to various factors.…”

Letter to: acute respiratory distress syndrome in traumatic brain injury: how do we manage it?

“…Current clinical practice is represented by a survey from Swiss intensivists, who regarded transpulmonary thermodilution as the most appropriate tool for extended hemodynamic monitoring, and CO and EVLW as most frequently used parameters, in patients with ARDS or septic shock (9). Transpulmonary thermodilution is also useful for the repetitive calibration of continuous CO from the arterial pressure waveform, which also provides important dynamic parameters (i.e., pulse pressure variation, stroke volume variation) for the assessment of fluid responsiveness in ventilated patients.…”