Journal Spells it Out: Haemodynamic Management Matters

October’s Clinical Services Journal includes an article that should be essential reading for the anaesthetist who wants to deliver optimal care. That’s because it gets down to the bare bones of haemodynamic management, why it matters and how to do it.

The challenge faced by both clinicians and purveyors of helpful technology (such as Deltex) is one of data. While surgical mortality, particularly in high risk patients, is tangible and measurable, reduction in lifespan is less easy to determine. Few clinical studies can claim to have done so. It turns out, from the existing literature, that 22 types of complication occurring within 30 days of surgery, will have a negative impact on the patient. Suffer a complication within 30 days and survival is reduced by 69%! It’s a staggering statistic… most people enter hospital expecting to get better, certainly not suffer the consequences of conditions they didn’t have when they arrived!

Haemodynamic Management Reduces Risk

Published outcome studies show that 51% of reported deaths and postoperative complications are a consequence of poor haemodynamic management. The good news is that these complications are mostly avoidable. As the article states, keeping organs well perfused during surgery “demonstrably reduces the risk of life threatening post-operative complications.”

Not all Cardiac Output Monitors are the same

This article should be something of a bible for the interested clinician. It is written by Dr Graham Lowe, Chief Operating Officer of Deltex, the company with the deepest roots in direct flow haemodynamic monitoring. The piece explains the failings of devices that do not measure blood flow directly. It highlights the flaws inherent in deriving blood flow data from arterial blood pressure, specifically the potential for them to deliver erroneous information in the presence of vasoactive drugs. The analogy of the effect of a vasopressor goes something like this; “step on the hosepipe and pressure goes up… but flow actually (and unhelpfully) goes down!”

Technology leadership in action

Deltex Medical, recognised technology leader in haemodynamic management, has been around for a few decades, but it hasn’t stood still. The company continues to push the boundaries of what can be achieved by clinicians who engage with its technology. Most recently Deltex has worked with leading researchers to complete the picture delivered to the anaesthetist. So-called “VP Loops” simultaneously plots aortic blood flow velocity against arterial blood pressure 180 times a second! In so doing it delivers a graphical representation of the impact of clinical interventions such as application of vasopressors on every heart beat. This incredible clinical precision makes it the only system accurate enough to immediately identify haemodynamic risk and keep the patient right in the sweet spot. Deltex is gently rebranding its ODM system to TrueVue, this describing the complete picture it provides to the operator. As the slogan goes; “see what we see!”

Better care at lower cost

As a description of how TrueVue adds to the proven ODM platform, this article is comprehensive and more than a little persuasive. As a clinician, while it’s easy to deal in the here and now, big data tells us that the consequences of actions undertaken in the clinical setting are more nuanced, significant and long-lasting than current practice might lead us to believe. Understand that and healthcare providers open up the door to better results. TrueVue is an easy-to-use technological solution that is proven in study after study to have a significant positive impact on clinical outcomes. Deltex’s position is that managing haemodynamics matters if we are to deliver better care at lower cost. With today’s healthcare challenges, that’s a pretty compelling argument.

The Clinical Services Journal article, titled “Blood flow, blood pressure or both” can be found in the October 2018 edition, available on paper at time of writing with online publication to follow. Find the CSJ website here.

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