ArticleJournal of clinical monitoring and computing2016
The effects of advanced monitoring on hemodynamic management in critically ill patients: a pre and post questionnaire study.
Article in Journal of clinical monitoring and computing, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 52 citations in OpenAlex.
- Clinical decision guidance by an automated, brachial cuff-based cardiac output assessment in patients with shock under treatment: a pilot study in Athens, Greece.Acute and critical care · 2025Article
- Continuous cardiac output assessment or serial echocardiography during septic shock resuscitation?Annals of translational medicine · 2020Review
- A Bayesian Network Analysis of the Diagnostic Process and Its Accuracy to Determine How Clinicians Estimate Cardiac Function in Critically Ill Patients: Prospective Observational Cohort Study.JMIR medical informatics · 2019Article
- Clinical examination: a trigger but not a substitute for hemodynamic evaluation.Intensive care medicine · 2019Article
- The diagnostic accuracy of clinical examination for estimating cardiac index in critically ill patients: the Simple Intensive Care Studies-I.Intensive care medicine · 2019Observational
- Alternatives to the Swan-Ganz catheter.Intensive care medicine · 2018Review
- Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy.Annals of intensive care · 2018Review
- Advanced hemodynamic monitoring in intensive care medicine : A German web-based survey study.Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2018Article
- Clinical examination for diagnosing circulatory shock.Current opinion in critical care · 2017Review
- Transpulmonary thermodilution: advantages and limits.Critical care (London, England) · 2017Review
- Journal of Clinical Monitoring and Computing 2016 end of year summary: cardiovascular and hemodynamic monitoring.Journal of clinical monitoring and computing · 2017Review
- Hemodynamic monitoring in the era of evidence-based medicine.Critical care (London, England) · 2016Article
- Advanced hemodynamic monitoring in the critically ill patient: Nice to have or need to treat?Journal of clinical monitoring and computing · 2016Article
- Less invasive hemodynamic monitoring in critically ill patients.Intensive care medicine · 2016Article
- Advanced Hemodynamic Management in Patients with Septic Shock.BioMed research international · 2016Review
- Correlations between pulmonary artery pressures and inferior vena cava collapsibility in critically ill surgical patients: An exploratory study.International journal of critical illness and injury scienceArticle
Corrections and comments
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Authors and funding
10 authors at 10 institutions in 8 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In critically ill patients, many decisions depend on accurate assessment of the hemodynamic status. We evaluated the accuracy of physicians' conventional hemodynamic assessment and the impact that additional advanced monitoring had on therapeutic decisions. Physicians from seven European countries filled in a questionnaire in patients in whom advanced hemodynamic monitoring using transpulmonary thermodilution (PiCCO system; Pulsion Medical Systems SE, Feldkirchen, Germany) was going to be initialized as part of routine care. The collected information included the currently proposed therapeutic intervention(s) and a prediction of the expected transpulmonary thermodilution-derived variables. After transpulmonary thermodilution measurements, physicians recorded any changes that were eventually made in the original therapeutic plan. A total of 315 questionnaires pertaining to 206 patients were completed. The mean difference (±standard deviation; 95 % limits of agreement) between estimated and measured hemodynamic variables was -1.54 (±2.16; -5.77 to 2.69) L/min for the cardiac output (CO), -74 (±235; -536 to 387) mL/m(2) for the global end-diastolic volume index (GEDVI), and -0.5 (±5.2; -10.6 to 9.7) mL/kg for the extravascular lung water index (EVLWI). The percentage error for the CO, GEDVI, and EVLWI was 66, 64, and 95 %, respectively. In 54 % of cases physicians underestimated the actual CO by more than 20 %. The information provided by the additional advanced monitoring led 33, 22, 22, and 13 % of physicians to change their decisions about fluids, inotropes, vasoconstrictors, and diuretics, respectively. The limited clinical ability of physicians to correctly assess the hemodynamic status, and the significant impact that more physiological information has on major therapeutic decisions, support the use of advanced hemodynamic monitoring in critically ill patients.
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