Patients who require hospitalization for COVID-19 are at an increased risk of developing conditions such as sepsis, acute lung injury (ALI), and acute respiratory distress syndrome (ARDS).1
Hemodynamic instability is a key contributor to mortality in patients with ARDS, and “successfully managing the complex hemodynamics of the ventilated patient with ARDS is key to patient survival.”2 The majority of patients needing ICU treatment will require mechanical ventilation.3 Existing evidence demonstrates critically ill patients who develop these complications are likely to develop multiple organ dysfunction syndrome (MODS) which significantly decreases the chance for patient survival, increases utilization of limited ICU and hospital resources, and ultimately results in an extended length of stay in both the ICU and hospital.4,5
Cardiac output and stroke volume monitoring are recommended in assessing individual patient response to fluids, vasopressors, or inotropes.7 More invasive monitoring, such as the Swan-Ganz pulmonary artery catheter, is indicated in more complex patients such as patients with refractory shock, ARDS, and right ventricular dysfunction.7 These devices provide additional parameters such as right-sided heart pressures, continuous mixed venous oximetry (SvO2), and volumetric parameters such as right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume (RVEDV).
Hemodynamic monitoring may add additional value in this phase of care, as it allows sequential evaluation of the patient9 and their individual response to therapies.7 This may contribute to early identification of developing complications such as cardiac dysfunction and/or low flow states which may occur.7 For example, patients with ARDS are commonly managed with strategies which may negatively impact patient hemodynamics.1 Restrictive or conservative fluid management may result in inadequate tissue perfusion.10
Fluid imbalance leads to complications10
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