A 66-year-old man is admitted to the SICU after undergoing emergent surgery for a colon perforation. The patient had coded in the OR and his history included prior CABG Surgery LidCO calculated Cardiac Index of 1.0 in the ICU is clearly misleading. As this index is derived from other measurements all numbers used to assess hemodynamic status were suspect. Patient was on three pressors for treatment based on this inaccurate data.
The attending ICU physician ordered a bedside transesophageal echo (TEE) exam using the ClariTEE™ probe (ImaCor, Inc, Uniondale, NY).
Using the ClariTEE™ a short-axis view (TGSAV) of the left ventricle was rapidly obtained. The patient was found to be normovolemic in sharp contrast to what the Lidco reading had indicated. Because LV function was better than expected as revealed by the TEE images, pressors were weaned. The Inferior wall was noted to be hypokinetic consistent with a history of MI, CAD, CABG and MV repair. The attendant physician instructed the nurse to “Get that out of here” referring to the Lidco device. Hemodynamics would now be monitored using the ClariTEE.
TGSAV view indicates normovolemic and better LV function than was indicated by the LidCO index.
Fluids are adjusted and pressors are weaned completely before next imaging session. Patient is hemodynamically stable at 19 hrs post TEE. Renal failure prompts a dialysis run that removes 2 liters of fluid from patient. TEE is performed immediately after dialysis during a period of hemodynamic instability and the TEE reveals an under filled but reasonably well functioning LV chamber. Approximately 16 hrs later the patient has received 1.5 liters and now is hemodynamically stable with B/P of 150/70 and the physician is satisfied with volume and pressure status at this time. No LidCO or Swan was used in the monitoring of this patient after initial TEE assessment representing a cost savings. Pressor use was eliminated as well.