Critical Care Medicine

Adult

The most common applications of the non-invasive hemodynamic monitoring in critical care is for confirming the patient response to fluids when conducting a dynamic fluid challenge. By determining fluid responsiveness the diagnosis period is decreased, allowing for quicker initiation of proper treatment and potentially decreasing the patients overall length of stay.

Pediatrics

Septic shock is the 11th leading cause of death in the United States and the number 1 cause of death in the intensive care unit. [2] Because adults and pediatrics respond differently to septic shock, there are a specific set of clinical guidelines for treating pediatric septic shock. [3] Pediatric therapies for treating sepsis include fluid resuscitation for preload optimization, administration of ionotropes to improve contractility, and vasopressors to optimize afterload. Understanding a patient’s hemodynamic status is critical to treating septic shock. [4] The EC Monitors can provide continuous hemodynamic monitoring of parameters such as cardiac index and systemic vascular resistance. If used early in a patient’s care, EC Monitors could potentially lead to reduced mortality rates, reduced length of stay, and reduced cost to the intensive care unit. For more information, see our page on Pediatric Septic Shock.

Neonates: Potential Benefits

Currently neonatal critical care units (NICU) are limited to using only blood pressure and heart rate as quantitative methods for assessing the hemodynamic status of their patients. Measuring the stroke volume and cardiac output of patients in a completely non-invasive manner would be the ideal method for risk assessment, fluid and drug management in the NICU.

Case Study:

A patient in the NICU was treated with dopamine due to low mean arterial pressure (MAP). This caused the patient’s cardiac out ( CO) to increase but heart rate (HR) and mean artial pressure ( MAP) remained relatively stable. The attending physician did not consider that changes in CO and increased the dosage of dopamine in order to achieve a higher MAP. Shortly after dopamine was increased, the CO dropped significantly and only bounced back once the dosage was decrease due to intervention from clinician who considered the changes in CO. This case study demonstrates the risk of mismanagement due to a lack of monitoring tools for the assessment of assessment of patients’ hemodynamic status.


[1] Hata S, S. C. (2010). Reduced mortality with noninvasive hemodynamic monitoring of shock. Journal of Critical Care.

[2] Kenneth et al. (2011) National Vital Statistics Reports, Vol. 59, No. 4.,

[3] Hauser, G. J. (2007). Early Goal-Directed Therapy of Pediatric Septic Shock. Israeli Journal of Emergency Medicine.

[4] Brierley, J et al. (2009). Clinical practice parameters for hemodynamic support of pediatric and neonatal sepctic shock: 2007 update from the American College of Critical Care Medicine, Crit Care Med Vol 37, No. 2.

[5] Brian Scottoline, M. (2011). Case Study: Electrical Cardiometry Trends CO during Management of Neonate with Dopamine. Palo Alto.