I DON'T need ultrasound monitoring on the ICU
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Transcript of I DON'T need ultrasound monitoring on the ICU
WHY EVERYONE SHOULD KNOW ABOUT CRITICAL CARE ULTRASOUND
Ultrasound monitoring
WHY EVERYONE SHOULD KNOW ABOUT CRITICAL CARE ULTRASOUND
Ultrasound monitoring
Points to ponder
• Have you got an Echo machine?• Have you got an US machine?• Are you competently trained in
Echo/US?• Are all the doctor colleagues in
your dept trained to use AND interpret the images?
• Are your nurses trained to follow the clinical protocols and pathways from the images obtained?
The perfect
monitor
• Precision• Accuracy•Reproducible•Continuous
We suggest that, when further hemodynamic assessment is needed, echocardiography is the preferred modality to initially evaluate the type of shock as opposed to more invasive technologies. Level 2; QoE moderate (B)Echocardiography can be used for the sequential evaluation of cardiac function in shock. Statement of fact
• no hemodynamic monitoring technique can improve outcome by itself
• monitoring requirements may vary over time and can depend on local equipment availability and training
• there are no optimal hemodynamic values that are applicable to all patients
• we need to combine and integrate variables
• measurements of SvO2 can be helpful
• a high cardiac output and a high SvO2 are not always best
• cardiac output is estimated, not measured
• monitoring hemodynamic changes over short periods of time is important
• continuous measurement of all hemodynamic variables is preferable
• non-invasiveness is not the only issue
A fool with a tool is a dangerous fool
Summary
• No monitoring device improves outcome without being paired to appropriate treatment• A good diagnostic/procedural tool does not necessarily mean a good monitoring tool• Just because you can, doesn’t mean you should