University of Florida Team At Shands Performs Surgical First In North America To Monitor Cardiac Blood Flow In Critical Care Patients

Until now, standard practice to gauge cardiac output involved insertion of a catheter into the patient's heart. However, Shands at UF patients now are the first to benefit from an FDA-approved method known as the LiDCO system, a minimally invasive hemodynamic monitoring system. This method eliminates the need for a separate catheter, drastically reduces medical risks and costs, and will make this crucial monitoring available to approximately 25 percent of the 6 millionintensive care patients treated annually in the United States.

The 65-year-old South Florida man who received the hemodynamic monitoring as part of his treatment for an esophagealperforation was listed in stable condition Thursday and is expected to recover fully.

"The FDA approved this method in the United States in January and we are the first to implement it," said Dr. James Gallagher, UF chief of critical care medicine. "The old method was too risky and expensive to use on all the patients who could benefit from it, but now we can offer this vital monitoring method to everyone who needs it."

Hemodynamic (blood circulation) monitoring allows the critical care team to use a patient's existing intravenous line, into which specially trained critical care nurses inject a lithium solution. Advanced computer technology measures the blood's lithium level and displays it on a portable computer. The equipment, created by United Kingdom-basedmedical technology company LiDCO Ltd., was developed at St. Thomas' Hospital in London and has been used in the United Kingdom for three years.

"Shands at UF has an international reputation in the use of advanced critical care technology," said Dr. Terry O'Brien, a medical technology specialist and founding director at LiDCO. "We are excited to work with this skilled intensive care team led by Dr. Gallagher." O'Brien was in Gainesville this week to train intensive care nursing staff to use the special equipment.

"Being trained in this method reinforces our commitment as criticalcare nurses to provide care that promotes patient comfort through the use of cutting-edge technology," said Jeannette Benken, a nurse coordinator in Shands at UF surgical intensive care unit.

The most important data for determining heart and circulatory system function include basic hemodynamic variables of blood pressure, blood flow and vascular resistance. These measurements can be made with existing medical technology, but because of its invasive nature, high cost and necessary skill base, its use is restricted to only a small percentage of the critical care patients in whom these measurementswould be useful.

Gallagher, a UF College of Medicine professor of anesthesiologyand surgery, has practiced at Shands HealthCare's teaching hospital for 18 years. He says hemodynamic monitoring with lithium is accurate, fast, relatively simple and avoids the hazards of pulmonary artery catheterization. According to LiDCO, approximately 10 million critical care patients worldwide will benefit from this method, which currently is approved for adults only.

"The good news for patients is that in our European clinical trials,we recorded no apparent side effects," said O'Brien. "Coupled with itsaccessibility and cost effectiveness, this treatment certainly is a medicalbreakthrough for North America."

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