The principles of augmenting the cardiac output in adults

Augmentation of the patient's cardiac output to optimize tissue oxygenation is a primary role of intensive and cardiac care nurses. This involves three approaches: the use of intravenous colloids and occasionally crystalloids, creating a passive stretching of the myocardium to increase cardiac output, the use of inotropic agents which directly stimulate the heart and finally and less commonly the use of cardiac assist devices, notably the intra aortic balloon pump. The choice of method will be dictated by the presenting clinical data and the perceived benefits to the patient of each approach. The role of nurses as part of the health care team is to practice safe, informed care, through an understanding of both the advantages and disadvantages of each approach to the clinical scenario encountered. This paper contains exploration of each of the three principles with a case study approach, allowing the reader to consider a variety of presenting clinical data and appropriate haemodynamic manipulation.