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.
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 pathophyiological mechanisms.4
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.
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