The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

COMPARISON OFCLINICIAN ASSESSMENT OF HEMODYNAMIC STATUS WITH ACTUAL DATA OBTAINED THROUGHA MINIMALLY INVASIVE LITHIUM DILUTION METHOD

Siddall, V.J.,MS, RRT, CCRC, Gould, R.W., MD, Peruzzi, W.T., MD. Critical Care Medicine,Dept. of Anesthesiology, Northwestern Memorial Hospital and Northwestern UniversityMedical School, Chicago, IL

Background: Advances in technologypermit a variety of invasive, minimally invasive, and non-invasive monitoringoptions for clinicians to utilize in the care of ill patients. This poses acomplex issue of determining what monitoring device should be used to provideaccurate, timely information in the least invasive manner. A minimally invasivemethod of obtaining cardiac output and systemic vascular resistance throughthe use of lithium chloride has been developed (LiDCO, LTD. London, UK.). Thissystem has been shown to be at least as accurate as thermodilution and avoidssome of the potential risks with placement of a pulmonary artery catheter (1,2).In this study, we examined whether utilization of the Lithium Dilution CardiacOutput (LiDCO) system provided clinical information that changed the opinionof the clinicians regarding the hemodynamic status of patients and if this informationaltered treatment plans.

Methods: Information was gatheredas part of a clinical assessment of device utility and data were analyzed afterIBR approval. Clinicians were asked to fill out a questionnaire at the bedsideregarding their clinical assessment of the hemodynamic status of the patient.A LiDCO determination was then performed on the patient and the results werecompared with the answers on the questionnaire. The clinicians were then askedif they were going to change the hemodynamic management of the patient basedon the results of the LiDCO.

Results: Fifty-one assessmentswere made. Data were analyzed via chi-squared test with Yates correction. Thedata indicated that practitioners were unable to identify the underlying hemodynamicstatus based on clinical assessment alone. Practitioners were unable to distinguishbetween CI and SVRI as the contributor to hemodynamic instability. When presentedwith LiDCO information, therapy aimed at hemodynamic support was changed ina significant number (24.7%) of patients.

Conclusion: This study demonstratesthe difficulty of determining hemodynamic status of patients on the basis ofclinical assessment alone. Additionally, the information provided by more advancedhemodynamic assessments altered therapy in a significant number of patients.The results suggest that LiDCO can offer rapid minimally invasive, and accurate,hemodynamic information that is not clinically evident and that can enhancedevelopment of focused treatment.

References:

Connors, A.F., et al. The effectivenessof right heart catheterization in critically ill patients. JAMA, 1996; 276:889-97.

Linton, R., et al. Lithium dilutioncardiac output measurement: A comparison with thermodilution. Critical CareMedicine. 1997;25(110): 1796-1800.

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