ISSN:
1432-055X
Keywords:
Schlüsselwörter Monitoring
;
Pulmonalarterienkatheter
;
Sv¯O2
;
kontinuierliche Herzzeitvolumenbestimmung
;
Kosten
;
kritisch Kranke
;
Key words Pulmonary artery catheter
;
Sv¯O2
;
Continuous cardiac output
;
Costs
;
Monitoring
;
Critically ill
;
Outcome
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Description / Table of Contents:
Abstract The introduction of flow-directed pulmonary artery (PA) catheters has helped to improve our knowledge of cardiovascular physiology. There have been several developments of this equipment in recent years, including continuous monitoring of mixed-venous O2 saturation (Sv¯O2) and cardiac output (CO). The high purchase price, however, is an obstacle to its use in the critically ill. The aim of the present study was to analyse the actual costs of these devices in comparison to standardly used intermittent monitoring of Sv¯O2 and CO. Methods. Thirty critically ill patients in a surgical intensive care unit (ICU) were prospectively studied. PA catheter monitoring was indicated by physicians who were not involved in the study. The patients were randomly allocated to one of the following groups: 1. a standard PA catheter was used, and Sv¯O2 and CO were intermittently measured 6 times a day on a routine basis and additionally when necessary from the clinical point of view; 2. Sv¯O2 was continuously measured using a fiberoptic PA catheter; and 3. CO was continuously monitored using a newly developed PA catheter. Costs for the catheter equipment and laboratory analyses (Sv¯O2) were calculated and the durations of intermittent monitoring techniques were measured. Costs for the `hardware' (monitor, blood gas analyser) were not taken into account. Sv¯O2 was measured by the ICU staff using an ICU-owned blood gas analyser (4.78 DM/analysis) and by a central laboratory unit, which had to be paid for its analyses (30.50 DM/analysis), respectively. Results. The groups were comparable with regard to their demographic data. A total of 378 intermittent measurements of Sv¯O2 and 449 mean CO measurements (1611 single bolus CO measurements) were carried out in the patients in whom a standard PA catheter was inserted. For daily calibration, a total of 50 single Sv¯O2 measurements were done in the group in which Sv¯O2 was continuously monitored. A total of 27.7 h were spent for intermittent Sv¯O2 measurements (time range of one analysis using the ICU-based blood gas analyser: 4.0 to 7.9 min); intermittent CO monitoring took a total of 14.2 h (time range of one mean CO measurement: 1.6 to 3.0 min). When blood gases were analysed by a central laboratory unit, costs for intermittent Sv¯O2 were tremendously higher than when monitored continuously. Conclusion. Monitoring devices that provide us with continuous information on the patient's state may have advantages in the management of the critically ill. Whether the patient's `outcome' can be improved by monitoring Sv¯O2 and CO continuously was not addressed by the present study. Instead, this study focused on the question of whether these devices are more cost-intensive than standard PA catheter monitoring systems. Costs for laboratory analyses can blunt the advantage of lower costs for the standard PA catheter. Intermittent (standard) monitoring of Sv¯O2 and CO was significantly more time-consuming than the continuous methods. It can be summarised that although purchase costs for the more advanced PA catheters are higher than for standard PA catheters, the use of these continuous monitoring devices in the critically ill can be justified from a financial point of view.
Notes:
Zusammenfassung 30 Patienten einer operativen Intensivstation, bei denen die Indikation eines erweiterten hämodynamischen Monitorings mittels Pulmonalarterien (PA-) Katheters gestellt worden war, wurden prospektiv untersucht. Randomisiert wurde folgende Gruppeneinteilung vorgenommen (10 Patienten pro Gruppe): 1. Ein Standard-PA-Katheter wurde eingesetzt, und die gemischt-venöse Sauerstoffsättigung (Sv¯O 2 ) sowie das Herzzeitvolumen (HZV) wurden routinemäßig 6mal am Tag und bei Bedarf zusätzlich bestimmt, 2. die Sv¯O 2 wurde kontinuierlich mit Hilfe eines Fiberoptikkatheters erfaßt und 3. das HZV wurde mit Hilfe eines neuentwickelten PA-Katheters kontinuierlich überwacht. Die Kosten für Einmalmaterialien und Laborkosten sowie der Zeitaufwand bei den intermittierenden Meßverfahren wurden über einen Zeitraum von 5 Tagen erfaßt. Neben den Kosten für die vom eigenen Pflegepersonal durchgeführten Blutgasanalysen mit Hilfe eines eigenen Blutgasanalysators wurde zusätzlich der Kostenanfall bei ,Fremd`bestimmung der Blutgasanalysen (durch das Zentrallabor) berechnet. Insgesamt wurden 378 Bestimmungen der Sv¯O 2 durchgeführt und 449 mittlere HZV-Werte erfaßt. Ohne Berücksichtigung des Zeitaufwands lagen die Kosten pro Patient bei der kontinuierlichen HZV-Bestimmung am höchsten. Bei der intermittierenden Sv¯O 2 -Bestimmung zeigte sich bei Einsatz des intensiveigenen Blutgasanalysegeräts eine Differenz von ca. 22,– DM/Tag zur kontinuierlichen Methode. Bei ,Fremd`bestimmung findet sich bei dem kontinuierlichen Verfahren ein deutlicher Vorteil. Zusammenfassend läßt sich feststellen, daß kontinuierliche Verfahren zur Überwachung kritisch Kranker von Vorteil erscheinen. Die höheren Kosten für die weiterentwickelten PA-Katheter wurden teilweise durch den Wegfall von Zusatzkosten, die bei den intermittierenden Verfahren entstehen, ausgeglichen. Der Wert einer deutlichen Entlastung des Intensivpersonals ist schwer abschätzbar, läßt aber den Einsatz dieser Verfahren als sinnvoll erscheinen.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001010050171
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