Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2015
A web-based Italian survey of current trends, habits and beliefs in hemodynamic monitoring and management.
Significant evidence outlines that the management of the high-risk surgical patient with perioperative hemodynamic optimization leads to significant benefits. This study aimed at studying the current practice of hemodynamic monitoring and management of Italian anesthesiologists. An invitation to participate in a web-based survey was published on the web site of the Società Italiana di Anestesia Analgesia Rianimazione Terapia Intensiva. ⋯ The most used parameter in clinical practice to assess the effects of volume loading were an increase in urine output and arterial blood pressure together with a decrease in heart rate and blood lactates. The 45.1% or the respondents outlined that hemodynamic optimization in the high risk patients is of major clinical value. Our study outlines an important gap between available evidence and clinical practice emphasizing the need for a better awareness, more information and knowledge on the specific topic.
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J Clin Monit Comput · Aug 2015
Observational StudyProspective evaluation of regional oxygen saturation to estimate central venous saturation in sepsis.
Current treatment guidelines for sepsis claim an early goal-directed hemodynamic optimization including fluid resuscitation, use of vasopressors and inotropic agents. We investigated the correlation between the prominent treatment goal central venous saturation (ScvO2) and the frontal and the thenar regional oxygen saturation (rSO2) measured by near infrared spectroscopy. Secondary, we examined the value of ScvO2, lactate levels and rSO2 as surrogate markers of an impaired tissue oxygenation for outcome prediction in sepsis. ⋯ In the group with ScvO2 <70% and lactate levels <2.5 mmol/l no patients died during the observation period. Frontal rSO2 correlates with ScvO2 but both frontal and thenar rSO2 do not exactly discriminate between patients with high or low ScvO2 in sepsis. The combination of elevated lactate >2.5 mmol/l and ScvO2 >70 % is highly associated with poor outcome in ICU patients with sepsis, severe sepsis and septic shock.
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J Clin Monit Comput · Aug 2015
The accuracy of respiratory rate assessment by doctors in a London teaching hospital: a cross-sectional study.
Respiratory rate (RR) is one of the most sensitive markers of a patient condition and a core aspect of multiple clinical assessment tools. Doctors use a number of methods to assess RR, including formal measurement, and 'spot' assessments, although this is not recommended. This study aimed to assess the accuracy of the methods of RR measurement being used by doctors. ⋯ We observed a trend towards decreasing accuracy of 'spot' assessments with increasing clinical experience (p = 0.0490). Current methods of RR assessment by doctors are inaccurate. This may be significantly delaying appropriate clinical care, or even misguiding treatment.