As understanding of the novel SARS-CoV-2 virus and resulting COVID-19 disease evolves almost daily, clinicians around the world are in constant discussions on how best to care for, treat, and manage patients with COVID-19 and resulting sepsis, septic shock, and/or acute respiratory distress syndrome (ARDS). Their focus is on supporting ideal oxygenation and maintaining appropriate fluid balance to minimize severe life-threatening complications. Included within this newsletter are resources that can help clinicians minimize the complexity of managing fluids in patients hospitalized with COVID-19.
Dr. Manuel Ignacio Monge Garcia, Staff Intensivist, discusses his perspective on management of the COVID patient in an interview with Professor Monty Mythen and Desiree Chappell, CRNA.
"I think that probably one of the main reasons for the impairment of the renal function could be related to our hemodynamic management of those patients. We try to do the same thing with the ARDS patient as with patients that are not ARDS patients. I mean, we saw patients with normal chest x-rays or almost normal, but we tried to keep those lungs dry. You see a lot of diuretics or trying to reduce the intake of fluids and probably that kind of management could impair the renal function."
The following is an example of how some hospitals are initially treating preload/volume with emphasis on the stroke volume response approach.
Stroke volume optimization % change in stroke volume (ΔSV) is a sensitive method for assessing preload responsiveness in all patients.
“No monitoring device, no matter how simple or complex, invasive or noninvasive, inaccurate or precise will improve outcomes unless coupled to a treatment, which itself improves outcome.”1
Pinsky and Payen
Created to support clinicians caring for surgical patients or the critically ill, the handy chart brings hemodynamic parameters and laboratory values together in one place.
Download the Normal Values card
While most people with COVID-19 develop mild or uncomplicated illness, approximately 14% develop severe disease requiring hospitalization and oxygen support and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by acute respiratory disease syndrome (ARDS), sepsis and septic shock, multiorgan failure, including acute kidney injury and cardiac injury.”2 “In a study of 150 patients from 2 hospitals in Wuhan, China, shock was a major reason for death in 40%, and may, at least in part, be due to fulminant myocarditis.”3
A primary reason for using advanced hemodynamic parameters for patients in shock, is to identify the type of shock in order to determine the most appropriate therapy. Prompt identification is essential so that aggressive management can be started. Appropriate treatment is based on an understanding of the underlying pathophysiological mechanisms.4
Studies show that individuals with suspected similar diseases (such as heart failure, sepsis, and stroke) present with widely diverse hemodynamic profiles.5. Trends in advanced parameters provide information on the underlying type of shock and enable clinicans to treat the specific type of shock more effectively.
Early, adequate hemodynamic support of patients in shock is crucial to prevent worsening organ dysfunction and failure.4
Correcting arterial hypotension is essential to restore blood pressure and provide adequate cellular metabolism, which is the primary goal of resuscitation.
After correction of hypoxemia and severe anemia, cardiac output (CO) is the principal determinant of oxygen delivery and achieving a CO that is compatible with tissue perfusion is also critical.
Measurements of mixed venous oxygen saturation (ScvO2, SvO2) may also be helpful in assessing the adequacy of the balance between oxygen demand and supply.4,6
Caution: Federal (United States) law restricts this device to sale by or on the order of a physician.
See Instructions For Use (IFU) / Directions For Use (DFU) for full prescribing information, including indications, contraindications, warnings, precautions and adverse events.
Please update to a current version of your preferred browser, this site will perform effectively on the following:Unable to update your browser?
If you are on a computer, that is maintained by an admin and you cannot install a new browser, ask your admin about it. If you can't change your browser because of compatibility issues, think about installing a second browser for browsing and keep this old one for compatibility