So anyone who knows Korbin (@khaycock2) realizes he is a true trailblazer in the ED, essentially doing cutting edge critical care from the get go in his shock patients. In my mind this should be the goal for any critically ill patients, that they get the highest level care right at entry and for however long they may be staying in the ED until they get to the ICU.
So today, I was really happy to corner Korbin lounging somewhere in sunny California (as 6 inches of snow come down hard in Montreal) to tell me how he is using this technology in his resus patients.
So this has got me interested in using this technology. I see it as an early warning signal that your patient may be less fluid tolerant than you may think, and that the signs of pulmonary fluid intolerance I use (oxygen requirement, appearance of B lines (FALLS Protocol-style), etc…) have yet to manifest.
So I’m looking forward to hearing Korbin explain this further (during H&R2020!) and in actual cases where the change in management is clear.
cheers
Philippe
thinking critical care 
Pulsion makes a nice device called the PiCCO which Does the IJ CVC-to-femoral-artery dilution but also gives an arterial waveform analysis (including a downslope time) to you help predict pulmonary edema, as well as PPV measurement to help assess fluid responsiveness. Nice device. I used it as resident, fellow and faculty in MICU for several years at a prior hospital but there is a learning curve and several assumptions that need to be acknowledged and can contribute to erroneous data. The flotrac by vigileo does something similar but doesn’t have the thermodilution so doesn’t have ability to calubrate it’s waveform analysis so I don’t find it as trustworthy.
Thanks for sharing! May give the PICCO a trial run!
There are 2 products in the market currently. DM me on Twitter if you’re curious. Thanks Edward!