Rapid response team review of hemodynamically unstable ward patients: The accuracy of cardiac index assessment

Eyeington, Christopher T; Lloyd-Donald, Patryck; Chan, Matthew J.; Eastwood, Glenn M; Young, Helen; Peck, Leah; Jones, Daryl; Bellomo, Rinaldo

doi:10.1016/j.jcrc.2018.09.002

Cited by 12 publications

(7 citation statements)

References 27 publications

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“…A previous study using the ClearSight™ device assessed 47 hospital‐ward patients who triggered a rapid response team review for HI. It found a similar rate of device data attainment (47/50, 94%) and a mean CI 2 . The same mean value for CI was observed in a 2008 study of 15 patients who presented with haemodynamic shock to tertiary hospital 25 .…”

Section: Discussionsupporting

confidence: 74%

“…It found a similar rate of device data attainment (47/50, 94%) and a mean CI. 2 The same mean value for CI was observed in a 2008 study of 15 patients who presented with haemodynamic shock to tertiary hospital. 25 However, these patients were mechanically ventilated, may have been ED or critical care patients, had already received therapy and were assessed using a pulmonary artery catheter.…”

Section: Relationship To Previous Studiessupporting

confidence: 65%

“…Approximately 300 000 adult patients present to major Australian EDs each month 1 . Haemodynamic instability (HI), previously defined as tachycardia or hypotension, 2 affects approximately 20% of non‐traumatic ED presentations, 3 with sepsis or systemic infection a major contributor. Several interventions are applied to restore haemodynamic stability, including fluid bolus therapy (FBT), vasopressors, inotropes or a combination of these 4,5 .…”

Section: Introductionmentioning

confidence: 99%

“…2 -test for categorical data. This analysis was undertaken with Stata 14 ® (StataCorp, College Station, TX, USA).…”

mentioning

confidence: 99%

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COMBED: Rapid non‐invasive Cardiac Output Monitoring Baseline assessment in adult Emergency Department patients with haemodynamic instability

Eyeington

Canet

Cutuli

et al. 2022

Emerg Medicine Australasia

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Objective The application of rapid, non‐operator‐dependent, non‐invasive cardiac output monitoring (COM) may provide early physiological information in ED patients with haemodynamic instability (HI). Our primary objective was to assess the feasibility of measuring pre‐intervention (baseline) cardiac index (CI) and associated haemodynamic parameters. Methods We performed a prospective observational study of adults shortly after presentation to the ED of a large university hospital with tachycardia or hypotension or both. We applied non‐invasive COM for 5 min and recorded CI, mean arterial pressure (MAP), stroke volume index (SVI) and systemic vascular resistance index (SVRI). We assessed for differences between those presenting with hypotension or hypotension and tachycardia with tachycardia alone and between those with or without suspected infection. Results We obtained haemodynamic parameters in 46 of 49 patients. In patients with hypotension or hypotension and tachycardia (n = 15) rather than tachycardia alone (n = 31), we observed a lower MAP (60.8 vs 87.7, P < 0.0001), CI (2.8 vs 3.9, P = 0.0167) and heart rate (85.5 vs 115.4, P < 0.0001). There was no difference in SVI (33.7 vs 33.4, P = 0.93) or SVRI (1970 vs 2088, P = 0.67). Patients with suspected infection had similar haemodynamic values except for a lower SVRI (1706 vs 2237, P = 0.011). Conclusions Rapid, non‐operator‐dependent, non‐invasive COM was possible in >90% of ED patients presenting with HI. Compared with tachycardia alone, patients with hypotension had lower CI, MAP and heart rate, while those with suspected infection had a lower SVRI. This technology provides novel insights into the early state of the circulation in ED patients with HI.

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Section: Discussionsupporting

confidence: 74%

Section: Relationship To Previous Studiessupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

“…2 -test for categorical data. This analysis was undertaken with Stata 14 ® (StataCorp, College Station, TX, USA).…”

mentioning

confidence: 99%

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COMBED: Rapid non‐invasive Cardiac Output Monitoring Baseline assessment in adult Emergency Department patients with haemodynamic instability

Eyeington

Canet

Cutuli

et al. 2022

Emerg Medicine Australasia

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“…Postoperative hypotension is commonly assumed to be caused by hypovolaemia and is often treated with rapid administration of an intravenous fluid bolus (IVFB). However, a normal-to-high nSVI accompanied by a low nSVRI may indicate vasodilatory hypotension, and in a mixed population of medico-surgical ward patients this haemodynamic profile has been shown to be common during episodes of hypotension [ 9 , 10 ]. Given that IVFB may be ineffective, or even harmful [ 4 ], more targeted treatment of postoperative hypotension might lead to improved clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Postoperative continuous non-invasive cardiac output monitoring on the ward: a feasibility study

King

Kermode

Saxena

et al. 2020

J Clin Monit Comput

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Postoperative hypotension is common (occurring in one third of patients) and is associated with worse clinical outcomes. The LiDCO CNAP (continuous non-invasive arterial pressure) device measures haemodynamics but has not been widely adopted in ward environments. Improved early detection of hypotension by CNAP might guide interventions to improve clinical outcomes. We aimed to find the proportion of patients who tolerated LiDCO CNAP for 12 h postoperatively, to unmask episodes of hypotension detected by continuous monitoring and to characterise the haemodynamic profile at the time of hypotension. In this feasibility study, patients undergoing major elective surgery were continuously postoperatively monitored using CNAP. Haemodynamic data gathered from CNAP, including nSVRI (nominal systemic vascular resistance index), nSVI (nominal stroke volume index), SVV (stroke volume variation) and blood pressure, were analysed using Microsoft Excel and GraphPad Prism 8. 104 patients (age (mean ± sd): 68 ± 14, male (56%)) had CNAP sited postoperatively. 39% tolerated the CNAP device for at least 12 h. Within the 104 patients a mean of 81.2 min of hypotension detected by CNAP was not detected by usual care. The proportion of low/normal/high nSVI was 71%, 27% and 2%, nSVRI was 43%, 17% and 40%, respectively. CNAP monitoring was not tolerated for 12 h in the majority of patients. There were many episodes of hypotension unmasked through continuous monitoring. Based on the advanced haemodynamic data provided it is possible that the underlying cause of a third of postoperative hypotensive episodes is vasodilation rather than hypovolaemia. Trial registry number: NCT04010058 (ClinicalTrials.gov) Date of registration: 08/07/2019.

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Postoperative ward monitoring – Why and what now?

Khanna

Ahuja

Weller

et al. 2019

Best Practice & Research Clinical Anaesthesiology

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Rapid response team review of hemodynamically unstable ward patients: The accuracy of cardiac index assessment

Cited by 12 publications

References 27 publications

COMBED: Rapid non‐invasive Cardiac Output Monitoring Baseline assessment in adult Emergency Department patients with haemodynamic instability

COMBED: Rapid non‐invasive Cardiac Output Monitoring Baseline assessment in adult Emergency Department patients with haemodynamic instability

Postoperative continuous non-invasive cardiac output monitoring on the ward: a feasibility study

Postoperative ward monitoring – Why and what now?

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