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drmwvr

drmwvr

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Arterial pulse wave analysis derived cardiac indices with new monitors and flash bang graphics...nursing 'leadership' pyramid pushing for this in the ICU's. The CT surgeons will be the ones suffering with the phone calls about SVV. I don't really care one way or the other because it's just another transducer to me and echo is right at hand. My bias is to not die on that hill because, in the end, it just doesn't matter. Peers have a different POV. Really like talking to a wall when talking to CC folks. What am I missing?
 
drmwvr said:
Arterial pulse wave analysis derived cardiac indices with new monitors and flash bang graphics...nursing 'leadership' pyramid pushing for this in the ICU's. The CT surgeons will be the ones suffering with the phone calls about SVV. I don't really care one way or the other because it's just another transducer to me and echo is right at hand. My bias is to not die on that hill because, in the end, it just doesn't matter. Peers have a different POV. Really like talking to a wall when talking to CC folks. What am I missing?
Click to expand...

I am a believer in SVV. I used it as a resident more than 10 years ago and I’m surprised how slow it is to catch on .
 
Most of the pulse contour analysis machines (Flotrac, Vigileo) are only validated for a very narrow set of patients, and have little utility beyond them. I've written in here before about when I was Army, hearts got a TEE, PAC, and Vigileo. The latter two used post-op. It was quite rare for all three to agree on the CO/CI (generally just if in SR, with 8ml/kg tidal volumes, minimal to no pressor or inotrope). Often, the vigileo would be waaaay off (like, claiming CI 4.4 when the other two were 2.2 and 2. 3). My ICU now had a few, and we've gotten rid of them all, as they were rarely utilized, and just seemed to give bad data.
 
I am in the camp that is convinced this is not reliable in the population that needs it.

The only one that benefits is the stockholders of Edwards.

I had a severe mitral regurg pt who had barely any cardiac output in cardiogenic shock. The Accumen (newer version of flowtrack) showed a cardiac output of 7 and a cardiac index of 3.
 
Or a higher up hospital exec has it approved to purchase at the request of their buddy who’s a rep/higher up at the device company touting better outcomes or some BS.

HCA tried to push these on everyone for the big ESR push 2-3 years ago and spent millions on expensive coat hangers.
 
We only place PA catheters for cases where we would require CCO monitoring in addition to TEE. Usually very low EF, balloon pumps, ECMO, severe pHTN, etc.

Otherwise most patients get a FloTrac, mostly for the ICU nurses to have some numbers to arbitrarily treat and feel good about. I barely look at the FloTrac monitor for a routine cardiac case.
 
Or, it leads them down the wrong path, to the detriment of the patient. I have a CT surgeon like that, and he can't look at the whole picture, just focuses on whatever single number is bad. MAP >70, CI >3, normal renal function, warm, ambulating, off all support, CXR a little wet, but SvO2 only 39%? Obviously, they need milrinone and Q2hr ABG/MVO2 for their brewing heart failure.
 
Has anyone tried the Edwards Acumen software? Sat in on a sponsored lunch talk at SCA once. Any believer?
 
psychbender said:
Or, it leads them down the wrong path, to the detriment of the patient. I have a CT surgeon like that, and he can't look at the whole picture, just focuses on whatever single number is bad. MAP >70, CI >3, normal renal function, warm, ambulating, off all support, CXR a little wet, but SvO2 only 39%? Obviously, they need milrinone and Q2hr ABG/MVO2 for their brewing heart failure.
Click to expand...

"Why's the PA diastolic negative?"

"It's not"

"Why's it say 40/-1 then?"

pacath-jpeg.362776
 
I don't really see the need for these... Some colleagues like them, but can't explain why or how they're useful/superior to other modalities. So our hospital doesn't buy them.
 
It takes only a moments consideration to dismiss this device as a piece of ****.
 
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