Designed to support your clinical decision making

  • Hemodynamic monitor;
  • ICU setting;
  • PulseCO™ software.

The LiDCOplus hemodynamic monitor provides a continuous, reliable and accurate assessment of the hemodynamic status of critical care and surgery patients. The LiDCOplus is comprised of two technologies: a continuous arterial waveform analysis system (PulseCO™) coupled to a single point lithium indicator dilution calibration system.

LiDCOplus offers

  • Highly accurate calibration enabling the effective titration of fluids and drugs;
  • Highly precise trends that have been shown to be effective in the presence of inotropes and vasopressors;
  • The ability to be used minimally invasively with the existing arterial line and no central line required;
  • A range of user interfaces to meet the requirements of the clinical setting.

Refer to the screen guide tab for further insights into how the flexibility of the displays can help meet your needs.

LiDCO Calibration Guide – How to set up the disposables

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LiDCO Calibration Guide – How to set up venous access

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LiDCO Calibration Guide – Useful information

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Sepsis | Reduced mortality with noninvasive hemodynamic monitoring of shock

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

RCT early GDT after major surgery reduces complications and LOS

RCT early GDT after major surgery reduces complications and LOS

Patient Population
Post-surgical intensive care.

LiDCO Monitor
LiDCOplus oxygen delivery (DO2) Early goal-directed therapy (EGDT) target.

Trial Design
Randomised LiDCOplus EGDT target vs usual care.

Outcome Impact
Fewer EGDT patients developed complications – 27 patients (44%) vs 41 patients (68%) LOS was significantly reduced (11 days vs 14 days) and the mean stay was reduced by 12 days (17.5 days versus 29.5 days) a 41% reduction. EGDT decreased costs by £2,631 per patient and by £2,134 per hospital survivor. EGDT was found to prolong quality-adjusted life expectancy (by 9.8 months) and to bring incremental cost savings of £1,285.

INTRODUCTION
Goal-directed therapy (GDT) has been shown to improve outcome when commenced before surgery. This requires pre-operative admission to the intensive care unit (ICU). In cardiac surgery, GDT has proved effective when commenced after surgery. The aim of this study was to evaluate the effect of post-operative GDT on the incidence of complications and duration of hospital stay in patients undergoing general surgery.

METHODS
This was a randomised controlled trial with concealed allocation. High-risk general surgical patients were allocated to post-operative GDT to attain an oxygen delivery index of 600 ml min(-1) m(-2) or to conventional management. Cardiac output was measured by lithium indicator dilution and pulse power analysis. Patients were followed up for 60 days.

RESULTS
Sixty-two patients were randomised to GDT and 60 patients to control treatment. The GDT group received more intravenous colloid (1,907 SD +/- 878 ml versus 1,204 SD +/- 898 ml; p < 0.0001) and dopexamine (55 patients (89%) versus 1 patient (2%); p < 0.0001). Fewer GDT patients developed complications (27 patients (44%) versus 41 patients (68%); p = 0.003, relative risk 0.63; 95% confidence intervals 0.46 to 0.87). The number of complications per patient was also reduced (0.7 SD +/- 0.9 per patient versus 1.5 SD +/- 1.5 per patient; p = 0.002). The median duration of hospital stay in the GDT group was significantly reduced (11 days (IQR 7 to 15) versus 14 days (IQR 11 to 27); p = 0.001). There was no significant difference in mortality (seven patients (11.3%) versus nine patients (15%); p = 0.59).

CONCLUSION
Post-operative GDT is associated with reductions in post-operative complications and duration of hospital stay. The beneficial effects of GDT may be achieved while avoiding the difficulties of pre-operative ICU admission.

Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial. Crit Care. 2005;9 (6):687-693 & Ebm C, Cecconi M, Sutton L, Rhodes A. A Cost-Effectiveness Analysis of Postoperative Goal-Directed Therapy for High-Risk Surgical Patients. Crit Care Med. 2014. DOI: 10.1097/CCM0000000000000164

Fewer EGDT patients developed complications – 27 patients (44%) vs 41 patients (68%) LOS was significantly reduced (11 days vs 14 days) and the mean stay was reduced by 12 days (17.5 days versus 29.5 days) a 41% reduction. EGDT decreased costs by £2,631 per patient and by £2,134 per hospital survivor. EGDT was found to prolong quality-adjusted life expectancy (by 9.8 months) and to bring incremental cost savings of £1,285.

Haemodynamic optimisation in lower limb arterial surgery: Room for improvement?

Haemodynamic optimisation in lower limb arterial surgery: Room for improvement?

Patient Population
High-risk peripheral vascular surgery.

LiDCO Monitor
LiDCOplus oxygen delivery (DO2) GDT target.

Trial Design
Randomised GDT vs standard care.

Outcome Impact
Significantly less fluid or adjusted all complications in the IGFT group.

BACKGROUND
Goal-directed therapy has been proposed to improve outcome in high-risk surgery patients. The aim of this study was to investigate whether individualised goal-directed therapy targeting stroke volume and oxygen delivery could reduce the number of patients with post-operative complications and shorten hospital length of stay after open elective lower limb arterial surgery.

METHODS
Forty patients scheduled for open elective lower limb arterial surgery were prospectively randomised. The LiDCOplus system was used for hemodynamic monitoring. In the intervention group, stroke volume index was optimised by administering 250 ml aliquots of colloid intra-operatively and during the first 6 h post-operatively. Following surgery, fluid optimisation was supplemented with dobutamine, if necessary, targeting an oxygen delivery index level ≥ 600 ml/min(/) m(2) in the intervention group. Central hemodynamic data were blinded in control patients. Patients were followed up after 30 days.

RESULTS
In the intervention group, stroke volume index, and cardiac index were higher throughout the treatment period (45 ± 10 vs. 41 ± 10 ml/m(2), P < 0.001, and 3.19 ± 0.73 vs. 2.77 ± 0.76 l/min(/) m(2), P < 0.001, respectively) as well as post-operative oxygen delivery index (527 ± 120 vs. 431 ± 130 ml/min(/) m(2), P < 0.001). In the same group, 5/20 patients had one or more complications vs. 11/20 in the control group (P = 0.05). After adjusting for pre-operative and intraoperative differences, the odds ratio for ≥ 1 complications was 0.18 (0.04-0.85) in the intervention group (P = 0.03). The median length of hospital stay did not differ between groups.

CONCLUSION
Peri-operative individualised goal-directed therapy may reduce post-operative complications in open elective lower limb arterial surgery.

The LiDCOplus is comprised of two technologies: a continuous arterial waveform analysis system (PulseCO™) coupled to a single point lithium indicator dilution calibration system.

PulseCO™

The PulseCO™ software provides continuous assessment of a patient’s hemodynamic status, by analysing and processing the arterial pressure signal obtained from a simple connection to the primary blood pressure monitor.

This concept of using the blood pressure waveform to measure blood flow changes has been validated in a wide range of conditions. This method provides cardiac output and associated values following calibration by an independent, preferably an indicator dilution based, cardiac output measurement.

The LiDCOplus bolus lithium indicator dilution method is a very accurate and minimally invasive method to measure cardiac output – and is used to calibrate the PulseCO™ arterial waveform stroke volume value.

The LiDCOplus monitor uses the lithium bolus indicator dilution method of measuring cardiac output. A small dose of lithium chloride is injected via a central or peripheral venous line; the resulting arterial lithium concentration-time curve is recorded by withdrawing arterial blood past a lithium sensor.

LiDCOplus, lithium bolus, calibration, cardiac output measurement

A bolus of lithium is flushed through a central or venous line

lithium sensitive sensor, cardiac output measurement, LiDCOplus, calibration

A lithium-sensitive sensor, attached to a peripheral arterial line, detects the concentration of lithium ions in the arterial blood


The lithium indicator dilution ‘wash out’ curve on the LiDCOplus provides an accurate absolute cardiac output value

Advantages of lithium calibration

The advantages of the LiDCOplus method are that it is safe, accurate and simple to use:

Safe – Central/peripheral venous and arterial catheters are usually already in place in patients needing cardiac output measurements. No further catheter is needed, so the method avoids the risks associated with more invasive arterial catheters.

The method requires the withdrawal of approximately 5ml blood per determination; for an adult, this is an insignificant amount. The injectate is a solution of lithium chloride. The dose needed (0.15 – 0.30mmol for an average adult) is very small and has no known pharmacological effect1.

Accurate – Clinical trials have been completed that demonstrate that the LiDCO system is at least as accurate as thermodilution2,3.

Simple to use – The method is simple and quick to use. It has the advantage that there is no unpleasant procedure for a conscious patient to undergo (such as insertion of femoral arterial line ) and the time taken to set up and apply is between 5 and 10 minutes4.

Validation

Validation comparing the LiDCO system with bolus pulmonary artery catheter thermodilution technique has demonstrated a good overall agreement between the two methods². The conclusions were that a single bolus of lithium was at least as accurate as mean triplicate bolus thermodilution. In a study where thermodilution and lithium dilution were compared to an aortic electromagnetic flow probe the LiDCO results showed less variability and therefore the LiDCO system was found to have a greater precision than single bolus thermodilution³.

Lithium Chloride

Multiple dosages of lithium have been extensively investigated and the safety profile is well established. The pharmacokinetics of intravenous lithium chloride in man (and animals) have been documented1, lithium chloride has been used extensively in medicine for prophylactic and therapeutic treatment of unipolar and bipolar manic-depressive disorders5,6. The lithium chloride is distributed throughout the total body water and excreted almost entirely by the kidneys. The half-life of lithium chloride in humans is 19.8 – 41.3 hrs7,8. The recommended maximum total dose for a lithium indicator dilution would have to be exceeded many times before toxic levels are reached. In fact, a single lithium chloride LiDCO indicator dilution determination at 0.3mmol is the equivalent to a steady-state plasma lithium concentration of 1/240th of the therapeutic level. Lithium has been used for the measurement of cardiac output in thousands of patients over many years without a single side effect being reported.

References

  1. Jonas MM, Linton RA, O’Brien TK, et al. The pharmacokinetics of intravenous lithium chloride in patients and normal volunteers. J Trace and Microprobe Tech. 2001;19:313-320.
  2. Linton RA, Band D, O’Brien TK, Jonas MM, Leach R. Lithium dilution cardiac output measurement: A comparison with thermodilution. Crit Care Med. 1997;25:1796-1800.
  3. Kurita T, Morita K, Kato S, Kikura M, Horie M, Ikeda K. Comparison of the accuracy of the lithium dilution technique with the thermodilution technique for measurement of cardiac output. Br J Anaesthesia. 1997;79:770-775.
  4. Jonas MM, Hett D, Morgan J. Real-time, continuous monitoring of cardiac output and oxygen delivery. Int J Intensive Care. 2002;9(1):33-42.
  5. Amidsen A. Lithium. In: Schentag et al, Applied pharmacokinetics: principles of therapeutic drug monitoring. San Francisco: Therapeutics Inc. 1980:586-617.
  6. Price LH, Heninger GR. Lithium in the treatment of mood disorders. N Engl J Med. 1994;331(9):591-8.
  7. Neilsen-Kudsk F, Amidsen A. Analysis of the Pharmacokinetics in man. Eur J Clin Pharmacol. 1979;16(4):271-277.
  8. Mason RW, McQueen EG, Keary PJ, James NM. Pharmacokinetics of lithium elimination and half-life, renal clearance and apparent volume distribution in schizophrenia. Clin Pharmacokinet. 1978;3:241-246.