Manden, R. (Renee) (2015) Non-invasieve hemodynamische metingen in de initiële fase op de SEH bij sepsis en niet sepsispatiënten : een pilotstudie. thesis, Medicine.
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Abstract
Sepsis is a clinical syndrome with a high prevalence in the emergency department. It is known as a complicated, systemic infection and the hemodynamic parameters are often highly inconsistent. Noteworthy is that the blood pressure often drops significantly, despite administering fluid therapy. By administrating fluid therapy, it is expected that the blood pressure either increases or remains constant. No golden standard exists for administrating fluid, and the amount of fluid is often empirically determined. It is important to know the spontaneous course of hemodynamic parameters, in order to accurately determine what the effect of fluid therapy will be and how much fluid should be administered. The NICOM measures stroke volume and cardiac output in a fast and non-invasive manner, these parameters play an important role in assessing the state of resuscitation of the patient. Furthermore, it becomes possible to investigate whether and how parameters used as diagnostic criteria for sepsis change when the hemodynamic parameters are being recorded. Also, the effect of fluid therapy on changes in the parameters can be studied. Objective: Registration of various hemodynamic and clinical parameters (including NICOM) in the emergency department, on both septic and non-septic patients, as well as the effect of fluid therapy on these parameters. Methods: During a period of 19 weeks, all patients admitted to the emergency department doctor or internal medicine were screened and divided in groups with either septic patients or non-septic patients. Screening for septic patients was carried out by using the Systemic Inflammatory Response Syndrome-criteria. Hemodynamic parameters were measured during the first hour after arrival on the emergency department. Some patients were connected to the NICOM, enabling stroke volume and cardiac output monitoring. Results: The hemodynamic measurements were useful with 106 patients. With 29 of these patients NICOM results were retrieved successfully. 3 patients presented with septic shock, another 3 patients presented with severe sepsis, and 25 patients presented with sepsis. After the initial hour there was a significant decrease in blood pressure and heart rate, both in septic and non-septic patients. Also at the baseline there were significant differences between septic and non-septic patients. Conclusion: The course of the hemodynamic parameters blood pressure and heart rate shows a spontaneous drop, regardless of the presence of sepsis and the amount of fluid therapy administered. For that reason, blood pressure and heart rate do not appear to be appropriate parameters to guide fluid therapy. It appears that in patients with a high heart rate, more fluid is being administered. A high heart rate is associated with a low stroke volume. It is possible that the decision to adjust fluids depends on a high heart rate.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultaire begeleiders: and Olgers T.J. & and Maaten, J.C. ter and Afdeling: Spoedeisende hulp and UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:42 |
| Last Modified: | 25 Jun 2020 10:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/389 |
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