Stable/Unstable? Cardiovascular Dynamics in Critically Ill Patients

There is currently doubt over the terms stable and unstable regarding cardiovascular dynamics in critically ill patients. Labelling a patient as haemodynamically stable or unstable can have different connotations depending on the practising physician.

 

The term stable is originally defined as the condition of the patient being unchanged for a substantial amount of time. However, if this is the case, all patients in the ICU would be defined as unstable, as the unpredictable nature of their condition is what makes these patients critically ill. For example, organ support can show some sort of stability in vital signs, however, this patient should still be considered as critically ill.

 

Main issues lie in the ill-defined nature of the terminology. As the terms stable and unstable are not uniform, they can vary depending on the doctor or nurse and their respective experience or knowledge of the patient. Instead of describing patients as ‘haemodynamically unstable’, there is a need to further describe cardiovascular dynamic conditions with terms such as circulatory shock.

 

Defining a patient as stable assumes positive outcomes, however, patients can still have ongoing conditions under this description, e.g. profound circulatory shock. The care team supporting the ‘stable’ patient still needs to remain vigilant for the underlying conditions putting the patient at risk. This term can also offer confusion to family members of the patient, making the severity of the patient’s condition unclear. Stable, in this case, can mean that the patient is not improving and there is a possibility that there will not be a positive outcome.

 

Terms to define stability in cardiovascular dynamics can vary among physicians and therefore clinical staff need to be certain that the condition of the patient is not misinterpreted. By further describing ‘haemodynamic instability’ with objective criteria such as cardiac output, blood pressure etc. can we be sure that the patient receives the appropriate care.

Source: Critical Care

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