Volume-limited versus pressure-limited hemodynamic management in septic and nonseptic shock
Critical Care Medicine,

Trof RJ et al. – Hemodynamic management guided by transpulmonary thermodilution vs. pulmonary artery catheter in shock did not affect ventilator-free days, lengths of stay, organ failures, and mortality of critically ill patients. Use of the a transpulmonary thermodilution algorithm resulted in more days on mechanical ventilation and intensive care unit length of stay compared with the pulmonary artery catheter algorithm in nonseptic shock but not in septic shock. This may relate to cardiac comorbidity and a more positive fluid balance with use of transpulmonary thermodilution in nonseptic shock.

Methods
  • A total 120 septic (n=72) and nonseptic (n=48) shock patients, randomized (after stratification) to transpulmonary thermodilution (n=60) or pulmonary artery catheter (n=60) between February 2007 and July 2009.
  • Hemodynamic management was guided by algorithms including upper limits for fluid resuscitation of extravascular lung water (<10mL/kg) and global end-diastolic volume index (<850mL/m2) in the transpulmonary thermodilution group and pulmonary artery occlusion pressure (<18-20mmHg) in the pulmonary artery catheter group for 72hrs after enrollment.

Results
  • Primary outcomes were ventilator-free days and lengths of stay in the intensive care unit and the hospital.
  • Secondary outcomes included organ failures and mortality.
  • Cardiac comorbidity was more frequent in nonseptic than in septic shock.
  • Ventilator-free days, lengths of stay, organ failures, and 28-day mortality (overall 33.3%) were similar between monitoring groups.
  • Transpulmonary thermodilution (vs. pulmonary artery catheter) monitoring was associated with more days on mechanical ventilation and longer intensive care unit and hospital lengths of stay in nonseptic (p=.001) but not in septic shock.
  • In both conditions, fewer patients met the upper limit of volume than of pressure criteria at baseline and transpulmonary thermodilution (vs. pulmonary artery catheter) monitoring was associated with a more positive fluid balance at 24hrs.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Anesthesiology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Anesthesiology Articles

1 The intubation scoop (i-scoop) - A new type of laryngoscope for difficult and normal airways Anaesthesia, June 12, 2014    Clinical Article

2 A nomogram for calculating the maximum dose of local anaesthetic Anaesthesia, May 13, 2014    Clinical Article

3 Routine pre-operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures Acta Anaesthesiologica Scandinavica, June 2, 2014    Clinical Article

4 Epinephrine, vasopressin and steroids for in-hospital cardiac arrest: The right cocktail therapy? Critical Care, June 6, 2014    Clinical Article

5 Major incidents and complications in otherwise healthy patients undergoing elective procedures: Results based on 1.37 million anaesthetic procedures British Journal of Anesthesia, June 25, 2014    Review Article

6 A survey of Canadian anesthesiologists preferences in difficult intubation and cannot intubate, cannot ventilate situations Canadian Journal of Anesthesia, June 11, 2014    Clinical Article

7 Statins and the risk of liver injury: A population-based case-control study Pharmacoepidemiology and Drug Safety, June 3, 2014    Clinical Article

8 Effects of fentanyl administration before induction of anesthesia and placement of the Laryngeal Mask Airway: A randomized, placebo-controlled trial Journal of Clinical Anesthesia, May 29, 2014    Clinical Article

9 Major incidents and complications in otherwise healthy patients undergoing elective procedures: Results based on 1.36 million anaesthetic procedures British Journal of Anesthesia, May 9, 2014    Review Article

10 Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: A retrospective study of consecutive patients Full Text BMC Anesthesiology, June 13, 2014    Free full text    Clinical Article

11 Volume of fluids administered during resuscitation for severe sepsis and septic shock and the development of the acute respiratory distress syndrome Journal of Critical Care, June 20, 2014    Clinical Article

12 Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery The Journal of Bone & Joint Surgery, June 10, 2014    Evidence Based Medicine    Clinical Article

13 Outcomes, measures and recovery after ambulatory surgery and anaesthesia: A review Current Anesthesiology Reports, June 9, 2014    Review Article

14 Comparison of continuous non-invasive finger arterial pressure monitoring with conventional intermittent automated arm arterial pressure measurement in patients under general anaesthesia British Journal of Anesthesia, June 24, 2014    Clinical Article

15 The impact of etomidate on mortality in trauma patients Canadian Journal of Anesthesia, April 14, 2014    Clinical Article

16 Pre-procedure ultrasound increases the success and safety of central venous catheterization British Journal of Anesthesia, June 19, 2014    Clinical Article

17 Relationship Between Diclofenac Dose and Risk of Gastrointestinal and Cardiovascular Events: Meta-Regression Based on Two Systematic Literature Reviews Clinical Therapeutics, June 17, 2014    Clinical Article

18 A systematic review and meta-analysis of the i-gel vs laryngeal mask airway in children Anaesthesia, June 5, 2014    Evidence Based Medicine

19 Risk of new or recurrent cancer after a high perioperative inspiratory oxygen fraction during abdominal surgery British Journal of Anesthesia, June 2, 2014    Clinical Article

20 Patients with obstructive sleep apnea for ambulatory surgery: Challenges and management Current Anesthesiology Reports, June 13, 2014    Clinical Article

Indexed Journals in Anesthesiology: Anaesthesia, Anesthesia & Analgesia, Current Anaesthesia and Critical Caremore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close