title: Practice of hemodynamic monitoring and management in German, Austrian, and Swiss intensive care units: the multicenter cross-sectional ICU-CardioMan Study.
abstract: BACKGROUND
  Hemodynamic instability is frequent and outcome-relevant in critical illness. The understanding of complex hemodynamic disturbances and their monitoring and management plays an important role in treatment of intensive care patients. An increasing number of treatment recommendations and guidelines in intensive care medicine emphasize hemodynamic goals, which go beyond the measurement of blood pressures. Yet, it is not known to which extent the infrastructural prerequisites for extended hemodynamic monitoring are given in intensive care units (ICUs) and how hemodynamic management is performed in clinical practice. Further, it is still unclear which factors trigger the use of extended hemodynamic monitoring.
  
  
  METHODS
  In this multicenter, 1-day (November 7, 2013, and the preceding 24 h) cross-sectional study, we retrieved data on patient monitoring from ICUs in Germany, Austria, and Switzerland by means of a web-based case report form. One hundred and sixty-one intensive care units contributed detailed information on availability of hemodynamic monitoring. In addition, detailed information on hemodynamic monitoring of 1789 patients that were treated on due date was collected, and independent factors triggering the use of extended hemodynamic monitoring were identified by multivariate analysis.
  
  
  RESULTS
  Besides basic monitoring with electrocardiography (ECG), pulse oximetry, and blood pressure monitoring, the majority of patients received invasive arterial (77.9 %) and central venous catheterization (55.2 %). All over, additional extended hemodynamic monitoring for assessment of cardiac output was only performed in 12.3 % of patients, while echocardiographic examination was used in only 1.9 %. The strongest independent predictors for the use of extended hemodynamic monitoring of any kind were mechanical ventilation, the need for catecholamine therapy, and treatment backed by protocols. In 71.6 % of patients in whom extended hemodynamic monitoring was added during the study period, this extension led to changes in treatment.
  
  
  CONCLUSIONS
  Extended hemodynamic monitoring, which goes beyond the measurement of blood pressures, to date plays a minor role in the surveillance of critically ill patients in German, Austrian, and Swiss ICUs. This includes also consensus-based recommended diagnostic and monitoring applications, such as echocardiography and cardiac output monitoring. Mechanical ventilation, the use of catecholamines, and treatment backed by protocol could be identified as factors independently associated with higher use of extended hemodynamic monitoring.
authors.affiliation: Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. s.funcke@uke.de.
authors.forename: Sandra
authors.initials: S
authors.lastname: Funcke
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, UKGM University Hospital Gießen, Justus-Liebig-University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Sander
authors.affiliation: Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Matthias S
authors.initials: MS
authors.lastname: Goepfert
authors.affiliation: Department of Anaesthesiology, Critical Care Medicine and Pain Medicine, University Hospital of Homburg/Saar, Kirrberger Strasse 100, 66421, Homburg, Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Groesdonk
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Heringlake
authors.affiliation: Department of Anaesthesia, Intensive Care, Emergency and Pain Medicine, Hospital Mechernich, St.-Elisabeth-Strasse 2-6, 53894, Mechernich, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Hirsch
authors.affiliation: Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluge
authors.affiliation: Department of Anaesthesiology, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Claus
authors.initials: C
authors.lastname: Krenn
authors.affiliation: Department of Intensive Care Medicine, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Maggiorini
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.affiliation: Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Cornelie
authors.initials: C
authors.lastname: Salzwedel
authors.affiliation: Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Saugel
authors.affiliation: Department of Clinical Medicine, Saarland University, Campus Homburg, Kirrberger Strasse 100, 66421, Homburg, Germany.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Wagenpfeil
authors.affiliation: Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Kirrberger Strasse 100, 66421, Homburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagenpfeil
authors.affiliation: Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Reuter
keywords: Cardiac output; Echocardiography; Guidelines; Hemodynamic management; Pulse contour analysis; Pulse pressure variation; Stroke volume variation; Thermodilution; Treatment protocol