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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill.

Atul Prabhakar Kulkarni1, Deepak Govil2, Srinivas Samavedam3

  • 1Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|March 10, 2023
PubMed
Summary
This summary is machine-generated.

These guidelines offer evidence-based recommendations for hemodynamic monitoring in critically ill patients in India. They address resource limitations and aim to standardize clinical practices for better patient outcomes.

Keywords:
Arterial lactateCardiac output measurementCentral venous oxygen saturationCritically ill adultsEchocardiographyHemodynamic monitoringStatic parametersThermodilution cardiac outputTranspulmonary thermodilution

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Area of Science:

  • Critical Care Medicine
  • Cardiovascular Physiology
  • Clinical Practice Guidelines

Background:

  • Hemodynamic monitoring is crucial for managing critically ill patients with acute circulatory failure.
  • Significant variations in Indian ICU infrastructure and clinical practices exist, potentially due to resource limitations and lack of awareness.
  • Existing practices highlight a need for standardized, evidence-based guidelines tailored to Indian healthcare settings.

Purpose of the Study:

  • To formulate evidence-based guidelines for the optimal use of hemodynamic monitoring modalities in critically ill patients in India.
  • To address the specific needs and resource-limited settings prevalent in Indian ICUs.
  • To improve clinical practices and patient outcomes through standardized monitoring protocols.

Main Methods:

  • Development of guidelines by the Indian Society of Critical Care Medicine (ISCCM) on behalf of its members.
  • Formulation based on existing evidence, with consensus-driven recommendations where evidence was insufficient.
  • Consideration of resource limitations and specific patient needs within the Indian context.

Main Results:

  • Established comprehensive guidelines for hemodynamic monitoring in critically ill patients.
  • Provided recommendations for various monitoring modalities, adapted for resource-constrained environments.
  • Emphasized the integration of clinical assessment with monitoring data for improved patient management.

Conclusions:

  • The guidelines aim to optimize hemodynamic monitoring practices in Indian ICUs, irrespective of infrastructure level.
  • Standardized application of these guidelines is expected to enhance the management of acute circulatory failure.
  • Integration of clinical judgment with monitoring data is key to improving patient outcomes in critical care settings.