The inability of emergency physicians to adequately clinically estimate the underlying hemodynamic profiles of acutely ill patients

Nowak, Richard M.; Sen, Ayan; García, Ana Isabel Morales; Wilkie, Heidi; Yang, James; Nowak, Michael R.; Moyer, Michele

doi:10.1016/j.ajem.2011.05.021

Cited by 24 publications

(15 citation statements)

References 16 publications

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“…Current guidelines suggest titrating fluid resuscitation to improving cold extremities, central capillary refill, peripheral pulse character and conscious state . These vital signs have, however, been shown to have limited value in predicting illness severity or response to treatment . Indeed, in a systematic review of FRT in adult sepsis, the median reduction in heart rate immediately post bolus was 2 beats per minute .…”

Section: Therapeutic Targetsmentioning

confidence: 99%

Fluid resuscitation therapy for paediatric sepsis

Long

Duke

2016

J Paediatrics Child Health

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Sepsis and septic shock are the final common pathway for many decompensated paediatric infections. Fluid resuscitation therapy has been the cornerstone of haemodynamic resuscitation in these children. Good evidence for equivalence between 0.9% saline and 4% albumin, with the relative expense of the latter, has meant that 0.9% saline is currently the most commonly used resuscitation fluid world-wide. Evidence for harm from the chloride load in 0.9% saline has generated interest in balanced solutions as first line resuscitation fluids. Their safety has been well established in observational studies, and they may well be the most reasonable default fluid for resuscitation. Semi-synthetic colloids have been associated with renal dysfunction and death and should be avoided. There is evidence for harm from excessive administration of any resuscitation fluid. Resuscitation fluid volumes should be treated in the same way as the dose of any other intravenously administered medication, and the potential benefits versus harms for the individual patient weighed prior to administration.

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Section: Therapeutic Targetsmentioning

confidence: 99%

Fluid resuscitation therapy for paediatric sepsis

Long

Duke

2016

J Paediatrics Child Health

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“…The Nexfin (BMEYE, Amsterdam, The Netherlands) utilising a finger-cuff technology based on the pulse-contour method can also be conveniently applied in the ED setting. 22,23 As for impedance cardiography, some work has already been done in ED patients with congestive heart failure and non-ED patients with hypertension; nonetheless more work still needs to be done in ED hypertensive patients. [17][18][19]23 …”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that emergency physicians cannot accurately estimate the underlying haemodynamic profile of acutely ill patients. 22,23 There are several non-invasive haemodynamic measuring devices available on the market. The Nexfin (BMEYE, Amsterdam, The Netherlands) utilising a finger-cuff technology based on the pulse-contour method can also be conveniently applied in the ED setting.…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic changes in emergency department patients with poorly controlled hypertension

et al. 2016

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Objectives: This study aimed to measure cardiac output, systemic vascular resistance, cardiac index, and systemic vascular resistance index in emergency department patients with poorly controlled hypertension; and to determine the frequency in which antihypertensive drugs prescribed do not address the predominant haemodynamic abnormality. Methods:This cross-sectional observational study was conducted in an emergency department of a 1400-bed tertiary hospital in Hong Kong. Patients aged 18 years or above, with systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥100 mm Hg based on two or more measurements and on two separate occasions within 2 to 14 days, were included. Haemodynamic measurements were obtained using a non-invasive Doppler ultrasound monitor. Doctors were blinded to the haemodynamic data. Any antihypertensive medication adjustment was evaluated for correlation with haemodynamic changes. Results:Overall, 164 patients were included. Their mean age was 69.0 years and 97 (59.1%) were females. Systemic vascular resistance and cardiac output were elevated in 65.8% (95% confidence interval, 57.9-72.9%) and 15.8% (10.8-22.5%) of patients, respectively. Systemic vascular resistance

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“…Moderate-to-reasonable correlations and a high percentage error were found when physician's estimates of continuous CO were compared to objectively measured CO [15,16,62 ▪▪ ]. Moderate-to-very poor agreements were found in studies that used weighted κ statistics to address agreement occurring by chance [55,59,60,67]. In addition, two studies reported that 21 and 26% of the CO estimations were completely disparate (an estimated high CO when the objective CO was low or vice versa) [55,59].…”

Section: Physician's Capacity To Estimate Co Based On Clinical Examinmentioning

confidence: 99%

“…The overall results appeared disappointing [13,14,16,17,53,54,56,58,60] (Table 2). Furthermore, two studies concluded that physicians more frequently overestimated (31–33%) rather than underestimated (18–23%) CO [14,57], implicating that physicians were more prone to miss an insufficient CO .…”

Section: Physician's Capacity To Estimate Co Based On Clinical Examinmentioning

confidence: 99%