Therapy Escalation

Failing on Current Therapy

When determining who should be considered for therapy escalation, there are several factors to consider. One important consideration is whether the patient is failing on their current therapy. If a patient is not responding to their current treatment plan, it may be necessary to escalate their care.

Some specific signs that the current therapy is failing on the patient include continued or increasing inotropic therapy, decreasing urine output, and increasing lactate levels. These are all indicators that the patient's condition is worsening and that their current treatment plan may not be sufficient.

Large Body Surface Area (BSA) And Hemodynamic Deficit

Another factor to consider is the patient's hemodynamic status. Patients with a large body surface area or significant hemodynamic deficits may require escalation of care to address their condition effectively.

Quantitative Judgement

Quantitative judgement is also essential when considering escalation. Healthcare providers should consider the patient's cardiac output and the duration of their hemodynamic deficit. Additionally, calculating Cardiac Power Output (CO x MAP/451) and PAPi (PA systolic-PA diastolic/ RA) can provide additional information to guide the decision-making process.

Ultimately, the decision to escalate care is complex and requires careful consideration of all available information. Healthcare providers must weigh the risks and benefits of escalation to determine the best course of action for each patient.