Edwards Lifesciences: COVID-19 support
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."
Read more from his interview here
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
Normal hemodynamic parameters and laboratory values
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
Physiologic implications of appropriate volume administration Learn more
Hemodynamic assessment and fluid management Learn more
Cardiovascular physiology 1 of 3 Learn more
Edwards clinical education website Learn more
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
Type of shock matters
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 clinicians to treat the specific type of shock more effectively.
Timely intervention is key
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
TopMed Talk COVID-19 podcasts
- Pinsky and Payen, doi.org/10.1007/3-540-26900-2_1.
- Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance V 1.2. (accessed 3.23.20).
- Alhazzani, Rhodes, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). European Society of Intensive Care Medicine and the Society of Critical Care Medicine 2020.
- Vincent & De Backer. Circulatory Shock. New England Journal of Medicine. 2013. 1726-1734.
- Nowak, RM ea al. Noninvasive hemodynamic monitoring in emergency patients with suspected heart failure, sepsis and stroke: the premium registry. West J Emerg Med 2014, 786-794.
- Zaja, J. Venous oximetry. Signa Vitae 2007; 2 (1): 6-10.
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