67 year old man, k/c of DM, HTN, presented with CAP, after initial fluids resuscitation, his Transpulmonary thermodilution device reading (EV1000 Volume view®️) showed the following picture.
What is the best next step?
Give more i.v fluids?
Start Vasopressors?
Give an Inodilator (Dobutamine)?
Fluid off-loading?
So giving Dobutamine will lead to:
Please note the significant rise in CI, GEF with reduction in the ELWI suggesting that the heart is functioning better and there is as you can see vasodilation as a consequence to Dobutmaine's vsodilator effect.
So the right approach would have been as you can see: 1 fluid bolus then dobutmaine. Vasopressors and 2nd iv fluids where detrimental.