Recent guidelines published by a Task Force of the ESICM and by the Surviving Sepsis Campaign highlight a need for continuous advanced hemodynamic measurements to guide fluid and drug management.
The LiDCO monitor systems can be used with an existing radial arterial line avoiding the use of more invasive catheters.
This means that monitoring can be started on admission to assess if the patient is fluid responsive and to start appropriate drug therapy.
Early monitoring with the LiDCO monitors in shock patients has been associated with a reduction in mortality when compared to other techniques.
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.
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.
Patient Population
Cardiac surgery patients following coronary artery bypass grafting and/or aortic valve surgery.
LiDCO Monitor
LiDCOplus.
Trial Design
Prospective observational study in cardiothoracic ICU.
Outcome Impact
A nurse-led GDT protocol targeting maximum SV for 8hrs post surgery showed a reduction in the incidence of AKI and reduction in the number of patients requiring RRT.
Consensus
Circulatory shock and hemodynamic monitoring.
Purpose
The purpose of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock.
Guidelines
Management of sepsis and septic shock.
Purpose
To provide an update to the Surviving Sepsis Campaign guidelines for Management of Sepsis and Septic Shock: 2012.
Appendices
Appendix 1. Recommendations and Best Practice Statement
Appendix 2. Comparison of Recommendations from 2012 to 2016
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