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Handelen we anders qua vullingbehoefte en inotropie als we de patiënt beter monitoren?.

By F.M. Groenwold

Abstract

Introduction: The function of the SG catheter was looked at and a literature survey was carried out in the use of the SG catheter in an ICU setting. The Swan-Ganz catheter (also called Pulmonary Artery Catheter PAC) is a flow directed pulmonary artery catheter and is designed to enable monitoring of hemodynamic pressures, continuous measurement of mixed venous oxygen saturation, and continuous cardiac output. For years the role of the pulmonary artery catheter (PAC) in ICU patients has been a topic of discussion. The use of PAC itself is not associated with improved outcome, and might contribute to increased morbidity. However, the influence of a therapeutic strategy, based on dynamic PAC-derived variables, has never been investigated. Aim of the study: The aim of this study is to evaluate whether such PAC-based strategy influences therapeutics in septic patients. The formulated general purpose of this study is as follows : Is there a difference in fluid balance and use of nor-adrenaline and dopamine after using PAC variables in patients with sepsis or septic shock compared with patients who are not monitored with a PAC but who are monitored using a central venous catheter. Materials and methods: A single centre retrospective case-control study in a 22-bedded mixed ICU was carried out. After introduction of a strict PAC-based resuscitation protocol, seventy patients with severe sepsis or septic shock (group 1), were compared with 70 matched controls (group 2), in which a central venous catheter was employed at the discretion of the attending physician. Primary outcomes were cumulative fluid balance and maximum dose of nor-adrenaline and dopamine during the first 24 hours. Secondary outcomes were morbidity and mortality and Length Of Stay (LOS) in the ICU and hospital, and mortality in the ICU and hospital where investigated. All the variables were collected from the medical notes, ICU day list, and an electronic database. The data were collected in the first 96 hours after ICU admission. All data were put in a data matrix in SPSS 15.1. The statistical analyses were carried out at the Medical Centre Leeuwarden. Results: When looking at baseline characteristics a higher age in group 2, and a difference in lactate and RIFLE-score was observed but there is no significant difference between the groups. In the primary outcome a significant difference between the groups when comparing fluid balance was seen. Patients in group 1 received significantly more fluid compared to group 2 during the first 24 hours after admission. The cumulative fluid balance and maximum dose of nor-adrenaline within the first 24 hours was significantly higher in the PAC group, when compared to group 2. However the total amount of fluid given in the first 7 days was significantly higher in group 2. In the secondary outcome no differences in severity of disease or predicted mortality using the APACHE ΙV and SOFA-scores where observed. But a significant difference in LOS ICU admissions in group 2 was seen. The duration of hospital

Year: 2010
OAI identifier: oai:ub.rug.nl:dbi/4dcb9236f229f
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