With what the Department of Health and Human Services calls an annual cost of up to $24 billion for hospitals, sepsis is one of the most costly and challenging conditions that hospitals face. Aggressive IV fluid therapy is often a vital intervention for hemodynamic support in severe sepsis, but determining the right amount of fluid requires special monitoring tools, which until recently have necessitated special training to use.
As the field aggressively pursues improved treatments, The University of Kansas Health System has found success with a tool from device company Cheetah Medical. Notably, in April of 2014, Kansas Health embarked on a six-month study using Cheetah’s noninvasive hemodynamic monitoring sensors, the Starling SV. With 191 patients participating, Kansas Health was able to reduce ICU length of stay by 2.89 days, lower risk of mechanical ventilation by 51 percent, and minimize the initiation of acute dialysis therapy by 13.25 percent for patients who underwent septic shock. Since then, Kansas Health has consistently used the Cheetah sensors and has realized $14 million in savings, helping more than 1,000 patients.
“We used [these sensors] as a tool to help guide us to see if patients would benefit from getting more fluid to help with their severe septic shock,” says Heath Latham, M.D., associate professor at University of Kansas Health System. “Clinically, we felt like they were beneficial, but we didn’t have any hard data. Nor was there any hard data out there. That's when we came up with our idea to embark on a study to look back.”
Here’s an overview of how the technology works: Patients who are being treated for septic shock are traditionally administered IV fluids to help their blood pressure from crashing. However, only about half of sepsis patients respond to these fluids. Also, dispensing the wrong amount can cause complications. By placing the Cheetah sensors on the patient's thorax, the sensors send small electrical signals to indicate whether the patient is responsive to the IV fluid.
“If you don't increase cardiac output, that fluid is staying in the heart and lungs, creating these worsening outcomes,” says Cheetah Medical’s CEO, Chris Hutchison. “Our technology enables the clinician to actually dynamically challenge the heart, give a little bit of fluid and actually watch the heart's response. And if —in response to that administration of volume —the cardiac output increases, [clinicians] know that it's safe to continue giving volume as they pursue their other therapeutic goals.”
Latham says Kansas Health has tried other technologies, but Cheetah’s wins out because, compared with other options, such as bedside ultrasound, there isn’t much of a learning curve to use it.
“You don't have to be skilled at a certain technique,” Latham explains. “Whereas a device like [Cheetah’s] can be placed by nursing or technicians.” Then, the monitor produces clinical numbers that pretty much all clinical staff can interpret and treat patients based on pre-defined protocol, Latham says. “And it doesn't require a physician standing there at the bed continuously.”
Adds Latham, “I think the main advantage is that globally, [these sensors] can be used by everybody involved in the health care team to take care of patients.”