Determining Appropriate Use Between Minimally Invasive And Non-invasive Hemodynamic Monitoring In The Shock Trauma ICU

Fluid resuscitation remains the mainstay of treatment for the hemodynamically unstable or hypotensive patient. Only approximately 50% of these patients are determined to have a therapeutic response to fluid administration also known as fluid responsiveness. Patients who receive over or under fluid resuscitation are at risk for harmful sequellae that can increase hospital length of stay, morbidity, and mortality. The bedside clinical assessment along with use of standardized hemodynamic measurements (central venous pressure/pulmonary artery wedge pressure) may be inaccurate and not reflective of fluid responsiveness. Technological advances have provided less invasive or non-invasive options to assist the bedside clinician in effectively determining fluid responsiveness. Devices such as the NICOM (Cheetah Medical, n.d.) and FloTrac (Edwards Lifescience, 2013) are currently available for use in the Shock Trauma Intensive Care Unit (STICU) at Intermountain Medical Center. Each technological device has distinct clinical indications and parameters for use. Due to the current medical teaching model of the STICU, many clinicians are unfamiliar with criteria for determination of device selection. This project included the following: an extensive review of existing literature on standard hemodynamic parameters utilized for fluid assessment, technological advances of minimally and non-invasive hemodynamic fluid assessment (NICOM/FloTrac) and clinical criteria for use; worksheet development for reference in determination of appropriate device selection (NICOM vs. FloTrac) in the STICU; upon approval from clinical experts, dissemination of worksheets to STICU bedside clinicians with request for formal and informal feedback; worksheets were submitted to STICU physicians for possible use in proposed journal submission.