DUKE UNIVERSITY STUDY SHOWS $3+ OF COSTS AVOIDED FOR EVERY $1 THEY SPEND USING NONINVASIVE HEMODYNAMIC MONITORING DURING SURGERY
Use of noninvasive hemodynamic monitoring for assessing fluid responsiveness in a wide range of circulatory conditions as part of a preemptive strategy for fluid optimization is associated with decreased Length Of Stay (LOS), morbidity, and mortality following surgery. Unfortunately, data on the cost-effectiveness and budget impact of hemodynamic monitoring devices perioperatively has been limited.
Now, Duke University assistant professor Thomas Hopkins, MD, Director of Quality Improvement at Duke University School of Medicine’s Anesthesiology Department, and colleagues have developed an innovative method—Budget Impact Analysis (“BIA”)—for determining the cost-effectiveness and budget impact of the capital investment necessary to support adding a noninvasive hemodynamic monitoring device to a hospital’s perioperative service offering. Dr. Hopkins presented his BIA data in a poster session during the most recent annual meeting of the American Society of Anesthesiologists (ASA).
“Our model shows more than $3 of costs avoided for each $1 spent perioperatively on noninvasive hemodynamic monitoring,” said Dr. Hopkins.
“While any validated hemodynamic monitoring device can be used in the model, the CHEETAH NICOM system was used for this BIA study by Duke,” said Adi Renbaum, Principal, ANR Consulting, who helped develop the BIA model. ”Nevertheless, the cost of monitors and sensors can be customized to remain pertinent to the hemodynamic monitoring device being considered for purchase.”
In addition to the strong economic reasons for adopting noninvasive hemodynamic monitoring, improved patient outcomes also underscores the rationale. Paul E. Marik, MD (Professor of Medicine and Chief, Div. of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, Va.) argued from the podium at the recent 4th International Fluid Academy Scientific Meeting that current standard of care guidelines for IV fluid management of critical care patients are “likely to lead to salt water drowning of these patients.”
Cardiac dysfunction manifests in a significant proportion of patients with severe infections, life-threatening trauma as well as those undergoing major surgery; this leads to insufficient cardiac output. Administration of IV fluids is usually the first step in resuscitating these patients. However, too much fluid can cause serious complications, increase the length of ICU and hospital stays, and increase the risk of death. Clinical studies have consistently shown that only about half of hemodynamically unstable critically ill patients are responsive to fluids.
Traditionally, patients undergoing surgery for traumatic injuries have been managed with a liberal IV fluid strategy, as recommended by the Advanced Trauma Life Support® (ATLS®) Student Course of the American College of Surgeons (ACS).
“There are, however, absolutely no human data to show that large volume IV fluid resuscitation reliably improves organ perfusion,” said Dr. Marik. “In fact, this approach is likely to lead to iatrogenic salt water drowning—caused by acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), myocardial injury, gastrointestinal dysfunction, and poor wound–healing with an increased risk of death.
“The physicians’ guide must be the measurement of cardiac output,” said Dr. Marik. “Traditional parameters routinely monitored today in the ICU and operating room — heart rate and blood pressure — are neither sensitive nor specific enough for timely identification of hemodynamic deterioration. Resuscitation of critically ill patients via IV fluids requires the ability to continuously monitor their cardiac output response following a fluid challenge,” Dr. Marik said.
“Key opinion leaders such as Dr. Marik and Dr. Hopkins are recognizing the enhanced patient benefits and the reduced costs attributed to fluid management. The FDA-cleared and CE-marked CHEETAH NICOM system is totally noninvasive and, using the power of Bioreactance®, is designed to be the very best technology for continuous fluid assessment in the operating room or a critical care setting,” said Chris Hutchison, President and CEO of Cheetah Medical.
The CHEETAH NICOM™ (NonInvasive Cardiac Output Monitoring) system is the only completely noninvasive product designed to provide real-time, continuous, and dynamic monitoring of IV fluids that has been validated against the previous ‘gold standards’ of PAC (Pulmonary Artery Catheter), EDM (Esophageal Doppler Monitoring), and thermo dilution catheter. CLICK HERE TO VIEW VIDEO, “A Physician’s Perspective.”
About Cheetah Medical
Headquartered in Newton, Mass., and approved in 60 countries including the U.S., Cheetah Medical is a rapidly growing medical device company with a breakthrough technology, CHEETAH NICOM™, designed to set a new standard of care for noninvasive, beat-to-beat, user- and patient-friendly cardiac output monitoring. CHEETAH NICOM has met with success in patients undergoing Guided Fluid Therapy during surgery, in critical care patients who are being fluid resuscitated to manage sepsis, and in trauma patients who have experienced high fluid loss. To learn more, please visit www.cheetah-medical.com
*“Evaluating the Cost-Effectiveness of Hemodynamic Monitoring Devices Used for Perioperative Fluid Optimization: A Preliminary Budget Impact Analysis (BIA)” prepared by Thomas Hopkins, MD, MBA; Tim Miller, MB, ChB; Tong Joo Gan, MD, MHS; Department of Anesthesiology, Duke University Medical Center, Durham, N.C. Presented as a Poster at the 2014 annual meeting of the American Society of Anesthesiologist (ASA)