"Current practice suggests that only one-third of patients with Sepsis receive excellent care." (Cooke CR, Iwashyna TJ. JAMA, 2014). Two significant studies have shown that early goal-directed therapy and invasive hemodynamic targets (CVP and ScvO2) fail to impact Sepsis patient outcomes. If now is not the time to change how we care for our Sepsis patients, when?
I attended the 27th Annual Meeting of ESICM in Barcelona where the preliminary results of the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial were first released. Once again ESICM's objective of advancing the knowledge of intensive care medicine was met, and I was encouraged by the growing conversations surrounding hTEE and advanced hemodynamic management. We were honored by Professor Michael Pinksy MD, Vice Chair of Academic Affairs of the University of Pittsburgh Medical Center, and Professor Antoine Vieillard-Baron MD PhD of CHU Ambroise Paré, incorporating hTEE into their presentations during the "Be on the Right Side of the Heart" session. Just three days later at the 27èmes Journées de la Pitié symposium for mechanical circulatory support at Pitié-Salpêtrière Hospital in Paris, I listened as Nadia Bouabdallaoui MD advocated for the use of hTEE.
Worldwide, the demand to implement Programs for Advanced Hemodynamic Management powered by hTEE is increasing rapidly. The program resonates with clinicians and hospital administrators alike as it emphasizes education, staff development, and implementing clinical best practices while remaining customizable to each hospital and unit.
The rationale behind the growing demand for Programs for Advanced Hemodynamic Management is made obvious by its benefits. Direct visualization of the heart over time, something not previously possible, is a safe and effective way to alter the negative trajectories of the most critically ill patients. Better outcomes and reduced length of stay are more attainable than ever before. While patients experience lower risks of complications and shorter ICU stays, hospitals gain improved patient safety and the potential for improved performance payouts/incentives. Programs for Advanced Hemodynamic Management improve outcomes, improve quality, and reduce costs. And in this era of Accountable Care, Programs for Advanced Hemodynamic Management ultimately reduce the escalating risks of this changing healthcare environment.
If not now, when?