Author(s): Kenneth Warring-Davies*
The revolutionary HeartSmart® continuous cardiac dynamic monitoring (CCDM) by way of empirical physiological formulae (EPF) embedded into an EPROM chip or in any other device with a personal computing platform, permits for haemodynamic monitoring at bedside, see diagram 3. The physiological parameters required to provide the haemodynamic variables are: heart rate, blood pressure, core body temperature degrees Celcius, height (cm) weight (kg) and mean central venous pressure the only parameter that is not non invasive. Caring for shocked septic – sepsis adult patients is a real challenge. The outcome of any interventional procedure to a great extent relies upon quality, simple, robust haemodynamic monitoring to guide fluid resuscitation with the use of vasopressors and or inotropes. Using the Bland-Altman method for comparing two measurement techniques, there was good agreement between measured and calculated Cardiac Index (Ci), Mean Pulmonary Artery Pressure (MPAP) and the Mean Pulmonary Artery Occlusion or Capillary Wedge Pressures (MPAOP / MPWP) The measured (PACTD) and calculated (HS) values of CI are identical agreement mean of differences (CI-0.095 to 0.295) The 95 % limits of agreement -3.662 to 3.861l / min / m 2 ), see Legend 1. The measured (PACTD) and calculated (HS) values of MPAP agreement the mean of differences PACTD 1.866 mmHg (CI 0.996 to 2.776) and for HS 1.383 mmHg (CI 0.557 to 2.210) The 95 % limits of agreement -15.266 to 19.037 mmHg for PACTD and -13.478 to 16.245 mmHg HS, see Legend 2. The measured (PACTD) and calculated (HS) values of MPWP agreement the mean of differences PACTD - 1.056 mmHg (CI-1.552 to -0.561) and for HS -1.312 (CI -1.764 to -0.860) The 95 % limits of agreement -10.529 to 8.416 mmHg for PACTD and -9.867 to 7.243 mmHg HS, see Legend 3. This indicates that, when estimating CI and MPWP in critically ill septic patients, CCDM-HeartSmart® provides values close to those generated using PACTD.