Haemodynamics Matter: New Study, Same Take-Homes

Haemodynamics Matter: New Study, Same Take-Homes

- 7 January, 2021

ICU Patient Study Points to Monitoring

Open access, peer-reviewed publication PLOS (Public Library Of Science), brings us a new and illuminating COVID-19 study. And again one clear take-home message is that haemodynamic monitoring is important.

Thomson et al: learning from 'first wave' experience in ICU

Found here, the paper describes the characteristics of severely ill patients with COVID-19 from the first wave of the Coronavirus pandemic in a UK hospital setting.

Investigators conducted a prospective observational cohort study of 156 patients with COVID-19 admitted to a large UK Intensive Care Unit (ICU) from March to May 2020. Follow-up ran to June 2020.

The goal was to understand the affected population admitted to ICUs. As a result the paper would inform clinical decision-making, research and planning for future (now current) waves of infection.

As with other studies, age, obesity and severity of respiratory failure were key determinants of survival. Notably, once again multiorgan failure was prevalent, with renal failure and thromboembolic complications featuring strongly.

'The majority of patients admitted to our ICU had multiorgan failure, defined as the requirement for at least two of respiratory, cardiovascular or renal support'

The clear implication is that organ perfusion really matters. Haemodynamic management experts at Deltex Medical point to two striking statements that say so:

Firstly: About Fluid

'Patients who died had higher positive cumulative fluid balance on the third (1,962 versus 1,350 ml, p = 0.045) and seventh (4,645 versus 1,332 ml, p<0.001) days of admission compared to those who survived'

Implication: As discussed extensively elsewhere on our pages, giving fluid is obviously important. But just as important is not giving too much. And the only way to know when to stop is to use proven, accurate, real-time haemodynamic monitoring.

Secondly: About Drug Administration

'Adequate plans to provide vasopressor and inotropic drugs by infusion, along with renal replacement therapy, must be made'

Implication: Accurate titration requires careful monitoring of haemodynamic impact that can guide clinicians with accuracy and in real time. ODM+ delivers on both fronts.

Stick to Haemodynamic Monitoring Basics and Optimise Outcomes

By now the world is used to the term mechanical ventilation, having heard little else through the early stages of the pandemic. However studies such as this point to COVID-19 patient care needing to be systemic as well as respiratory. To keep patients in the best haemodynamic place is to give them the best chance of avoiding the multiorgan problems that have resulted in death and long term problems. At Deltex Medical we'd argue that haemodynamic management of COVID-19 patients in ICU is therefore essential.

Deltex Medical CEO Andy Mears comments; 'It's been clear since the early stages of this pandemic that COVID-19 patients in ICU suffer from multiorgan conditions, particularly renal failure.

'At Deltex we've been repeating the mantra for many months. Haemodynamic management is absolutely vital if the most positive outcome possible is to be achieved for each patient.'

The only haemodynamic monitoring modality to be supported by a body of RCTs is oesophageal Doppler (ODM+) as featured on Deltex Medical's TrueVue platform.