Describe the role of cardiac output measurement in Intensive Care, including indications, and how it may change therapy.
The role of cardiac output measurement depends largely on local practice. Units will vary in both aggressiveness of determination of cardiac output (PA catheter, echocardiography etc.), and in the way that the information is used (targeting particular goals, having monitoring protocols). Much of our haemodynamic and respiratory management can be done without regular assessment of cardiac output. The levels of evidence to support roles, indications and changes in therapy should be provided
This complicated question did not merit a very detailed college answer, forcing me to elaborate upon this by myself.
One must be aware that the question refers to the role of cardiac output measurement in the ICU - not the merits of each specific method, or the risks vs benefits of cardiac output monitoring techniques.
Of course, how the hell do you provide levels of evidence for that?
Here is a table instead.
|
Indications for cardiac output monitoring |
Influence on management |
|
Deranged cardiac function in the context of shock |
Titration of fluids, inotropes and vasopressors |
|
Goal-directed resuscitation of complex multifactorial shock states |
|
|
Continuous monitoring following cardiac and non-cardiac surgery for high risk patients |
Early intervention for depressed cardiac function |
|
Protocol-driven management of hemodynamically unstable patients |
Standardised management algorithms driven by cardiac output monitoring can support management decisions |
Mathews, Lailu, and Kalyan RK Singh. "Cardiac output monitoring." Annals of cardiac anaesthesia 11.1 (2008).
de Waal, Eric EC, Frank Wappler, and Wolfgang F. Buhre. "Cardiac output monitoring." Current Opinion in Anesthesiology 22.1 (2009): 71-77.
Pinsky, Michael R. "Hemodynamic evaluation and monitoring in the ICU."CHEST Journal 132.6 (2007): 2020-2029.