ICU Cases · Haemodynamic monitoring
Hot case — the shocked patient at the bedside: reading the monitors
A CICM Second-Part hot case — the bedside monitoring encounter. The candidate works through the shocked postoperative patient at the bedside: confirms the arterial line is trustworthy (and catches an under-damped trace over-reading the systolic), rejects the central venous pressure as a fluid guide, performs a passive leg raise to test fluid responsiveness, reads the focused echo, and presents a real-time plan that matches each monitor to a decision — the haemodynamic discipline the examiner is scoring.
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Candidate brief. Mr D, 58, day 1 after an emergency laparotomy for a perforated viscus. He is hypotensive, the mean arterial pressure wandering between 58 and 66 mmHg on noradrenaline being up-titrated, and he has had two 500 mL fluid boluses with no sustained improvement. The arterial line trace looks tall and sharp; the central venous pressure reads 8 mmHg; the nurse asks whether to give more fluid.
[1]You have eight minutes to examine him, interpret the monitoring at the bedside, and prepare a structured assessment before the examiner arrives.[3]
References4ShowHide
- [1]Marik PE, Baram M, Vahid B. Does Central Venous Pressure Predict Fluid Responsiveness? A Systematic Review of the Correlated Literature. Chest, 2008.PMID 18628220
- [2]Monnet X, Rienzo M, Osman D, et al. Passive Leg Raising Predicts Fluid Responsiveness in the Critically Ill. Critical Care Medicine, 2006.PMID 16540963
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [4]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.