Sepsis | Reduced mortality with noninvasive hemodynamic monitoring of shock

Patient Population
ICU shock patients.

LiDCO Monitor
LiDCOplus.

Trial Design
Observational study comparing no hemodynamic monitoring vs pulmonary artery vs LiDCOplus managed shock patients.

Outcome Impact
Treatment of patients using the LiDCOplus monitor significantly reduced the observed mortality rate to 13% against 32% and 20% in the invasively monitored and 37% in the unmonitored patient groups.

PURPOSE
This study compared clinical outcomes associated with exposure to pulmonary artery catheters (PACs), central venous catheters (CVCs), arterial pressure waveform analysis for cardiac output (APCO), or no central monitoring (NCM) in patients with shock.

MATERIALS AND METHODS
We assessed 6,929 consecutive patients from 2003 to 2006 within a surgical intensive care unit of a university hospital, identifying 237 mechanically ventilated patients with shock.

RESULTS
Adjusted for severity of illness, use of APCO monitoring, compared with other options, was associated with reduced intensive care unit mortality (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.18-0.77) and 28-day mortality (OR, 0.43; 95% CI, 0.22-0.85). Other monitors were not associated with changes of 28-day mortality (CVC: OR, 0.63; 95% CI, 0.34-1.17; PAC: OR, 0.78; 95% CI, 0.36-1.69) or were associated with increased risk (NCM: OR, 2.29; 95% CI, 1.14-4.61). There were significant differences in the fluid and vasoactive drug prescriptions among the groups.

CONCLUSIONS
This study supports an association between the use of APCO monitoring and reduction in mortality in shock compared with traditional methods of monitoring. Although it is impossible to exclude the role of unrecognized/unrecorded differences among the groups, these findings may result from differences in supportive care, directed by monitor technology.

Hata J, Stotts C, Shelsky C, Bayman E, Frazier A, Wang J, Nickel E. Reduced mortality with noninvasive hemodynamic monitoring of shock. J Crit Care. 2011;26(2):224.E1-8.

Treatment of patients using the LiDCOplus monitor significantly reduced the observed mortality rate to 13% against 32% and 20% in the invasively monitored and 37% in the unmonitored patient groups

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