Terry, Can you share your protocols? At UTMB Dr. Luis Pacheco has developed a flow chart that he uses with CO or PPV using fluid bolus and PLR pending certain patient characteristics.
I will ask him if we can share these for your comments. George On 2/19/13 9:21 AM, "Terry Clemmer" <[email protected]> wrote: >George >It is called the Noninvasive Cardiac Output Monitor (NICOM) from an >Israeli company called Cheetah. It works by bioreactance rather than >bioimpedance and is more accurate and reliable. It works on spontaneous >breathing patients and those with dysrhythmias like atrial fibrillation. >The literature on it is quite good. I can send you some of the articles >if you like. We have been using it for a couple of years to predict fluid >responsiveness and have developed protocols around it. > >Terry P. Clemmer, MD >Director of Critical Care Medicine >LDS Hospital >8th Ave and 'C' Street >Salt Lake City, Utah 84143 > >Phone 801-408-3661 >E-mail: [email protected] > > >"Confidential Report for Improvement of Hospital, Facility and Patient >Care--Not Part of Medical Record and Not to be Used in >Litigation--Prepared Pursuant to Utah Code Ann. § 26-25-1 et seq., or >Idaho Code Ann. § 39-1392 et seq." > >-----Original Message----- >From: [email protected] >[mailto:[email protected]] On Behalf Of Kramer, >George C. >Sent: Sunday, February 17, 2013 6:26 AM >To: John Brady; [email protected]; [email protected]; >[email protected]; [email protected] >Cc: [email protected] >Subject: Re: [Sepsis Groups] Betr.: Re: volume required > >John, > >What technologies are your referring to. > >The ones on the market that I know about are > >Pulse contour CCO monitors (EV-1000, LidCO, PiCCO, Nexfin) Bioimpedance >Bioractance CCO ( Aseculon, ICON, Cheetah and Enduro) > >From: John Brady <[email protected]<mailto:[email protected]>> >Date: Friday, February 15, 2013 10:30 AM >To: "[email protected]<mailto:[email protected]>" ><[email protected]<mailto:[email protected]>>, >"[email protected]<mailto:[email protected]>" ><[email protected]<mailto:[email protected]>>, >"[email protected]<mailto:[email protected]>" ><[email protected]<mailto:[email protected]>>, >"[email protected]<mailto:[email protected]>" ><[email protected]<mailto:[email protected]>> >Cc: >"[email protected]<mailto:[email protected] >s.org>" ><[email protected]<mailto:[email protected] >s.org>> >Subject: Re: [Sepsis Groups] Betr.: Re: volume required > >We are exploring technology that allows us to non invasively monitor >hemodynamics ( co/CI, SV,SVR,) we are also exploring opportunity to >monitor CO/CI, SV.. with the use of an arterial line. > >I have information on each if anyone would be interested , we could talk >off line. > >John Brady RN,BSN,CCRN,CNRN >Quality Nurse Manager >St. Mary Medical Center >760 242 2311 ( 5369) > >From: >[email protected]<mailto:sepsisgroups-bounces@li >sts.sepsisgroups.org> >[mailto:[email protected]] On Behalf Of >[email protected]<mailto:[email protected]> >Sent: Friday, February 15, 2013 6:26 AM >To: [email protected]<mailto:[email protected]>; >[email protected]<mailto:[email protected]>; >[email protected]<mailto:[email protected]> >Cc: >[email protected]<mailto:[email protected] >.org> >Subject: Re: [Sepsis Groups] Betr.: Re: volume required > >Dr J : CVP is another useful measurement........regardeless of your >opinion which I do not agree What I do agree is that passive leg raising >is very helpfull, the most important is that one should use all the >tools available > >Regards > >From my HTC Sensation 4G on T-Mobile. The first nationwide 4G network >----- Reply message ----- >De: "Jo Krewinkel" <[email protected]<mailto:[email protected]>> >Para: <[email protected]<mailto:[email protected]>>, >"[email protected]<mailto:[email protected]>" ><[email protected]<mailto:[email protected]>>, ><[email protected]<mailto:[email protected]>> >CC: ><[email protected]<mailto:[email protected] >s.org>> >Asunto: Betr.: Re: [Sepsis Groups] volume required >Fecha: vie., feb. 15, 2013 4:37 a. m. > >+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=* >Antwoord gewenst Bij gelegenheid >+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=* >Why don't you use Passive Leg Rising to see if a patient is fluid >responsive, easy to use without any complication of overfilling and we >all know that CVP is not the right measurement to see if fluid works. >So please stop using this as a measurement for fluid-responsiviness J >Krewinkel RN ICU, circulation Practitioner Atrium MC Parkstad the >Netherlands > >Met vriendelijke groet, > >J. Krewinkel >Circulation Practitioner >Atrium MC Parkstad >[email protected]<mailto:[email protected]> >045-5767010 >[cid:[email protected]] >>>> [email protected]<[email protected]<mailto:juanpataro@hotm >>>> ail.com%[email protected]>> 2/12/2013 3:17 >>> >Fluid challenge is one of the most dificult things to do....sometimes you >just need 1 l of cristaloids on others you will use as much as 5 l.....as >it was mentioned above the clinical response is the goal....o others you >will need more tools like central venous pressure, svo2 Even measure the >diameter of inferior cava vein all these to estimate where are you >standing..... >Hope it helps >Juan pataro md >instituto argentino de riñon y transplante > >From my HTC Sensation 4G on T-Mobile. The first nationwide 4G network >----- Reply message ----- >De: "Rich Levrault" ><[email protected]<mailto:[email protected]>> >Para: "sandeep varma" ><[email protected]<mailto:[email protected]>> >CC: >"[email protected]<mailto:[email protected] >s.org>" ><[email protected]<mailto:[email protected] >s.org>> >Asunto: [Sepsis Groups] volume required >Fecha: dom., feb. 10, 2013 10:59 a. m. > >Fluid should be given until it fails to produce a clinically appropriate >response. Pulmonary edema is sometimes a necessary evil. > >Sent from Rich's iPhone > >On Feb 9, 2013, at 1:15 AM, sandeep varma ><[email protected]<mailto:[email protected]>> wrote: >hello all >i have a query regarding fluid volume requirement in sepsis. often have >seen blood pressure improvement after fluid bolus but only to see it fall >back after few minutes. the postulated theory behind this was leakage of >given fluid into interstitial causing intravascular depletion again. my >concern is that how much of fluid can be given this way? will this lead >on to pulmonary edema and interstitial edema without much helping in >building up intra vascular volume and aiding in stabilizing blood >pressure? >sandeep varma >thriuvananthapuram >kerala >india >_______________________________________________ >Sepsisgroups mailing list >[email protected]<mailto:[email protected] >.org> >http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >________________________________ >Notice from St. Joseph Health System: >Please note that the information contained in this message may be >privileged and confidential and protected from disclosure. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
