All about Monitoring 2: Critical Care Conference in Thailand 3rd

The ideal or how good of the monitoring would not be useful, if it does not help initiate the action plan to correct your patient or solve your patient 's problems. So, when you have a chance to monitor your patients, don't forget to think beyond what you can see from the screen, start to do the most appropriate procedure to manage your patient, then monitor again to see how things progress, and finally re-evaluate the effects from the actions you have put in. That is the Monitoring Truth.

Cardiac output monitoring; it just tells you the low flow state, the threshold value, in high risk surgical patient you do have to try to increase your patient the Oxygen Delivery to gain the better patient outcome. It should be somewhere from 450 ml/min/sq.m. to not over 600 ml/min/sq.m. because beyond 600 it would not be more helpful like it has passed the maximal effects.

Fluid resuscitation and Dobutamine: you have to do your best to prevent more morbidity in your patient by start the fluid management at the sooner point to get the better outcome, because it has been demonstrated that it would not be beneficial if you have done it too late especially when there is an organ failure in your patient. If you do/ manage your patient at the right time, it would help lessen the risk of perioperative cardiac complications especially the most common cause of dying, the congestive heart failure.

Choose the Right patient: in order to gain the highest possible benefit in your patient, you have to decide which patient you should perform or proceed the right action. In the right patient, if you have a goal directed fluid therapy, it has shown that the life expectancy of your patient can be lengthened by three more years in a 15 year follow up study. Fluid resuscitation in haemodynamic unstable patient would not be helpful in every single patient, it would help approximately half of the critically ill patient with circulatory shock when you started the process of management with a delay.

Please Stay tuned, for more from the Crit Care Conf en Thailande.