Table 1.
Survey Clinical Scenarios.
| Case Description | |
|---|---|
| Scenario A | 56 year old male with chronic nonischemic systolic heart failure admitted from clinic with NYHA class IIIb–IV symptoms and 20 pound weight gain on 100 mg torsemide. Not on home inotropes. 2nd CHF admission in 6 months. Baseline Cr 1.0 mg/dL. Admission Cr 1.5, ALT 20, INR 1.0. Currently on the telemetry (nonICU) floor on 0.125 mcg/kg/min milrinone and Lasix 10 mg/hr gtt. On day of operation, Cr 1.1 mg/dL, ALT 28 IU/L, INR 1.0. Swan on 0.125 mcg/kg/min milrinone following medical Rx: RA 9, PA 65/21, WP 20, CI 2.3. |
| Scenario B | 56 year old male with acute nonischemic biventricular heart failure in shock on admission who was placed on ECMO then bilateral Centrimags (Thoratec Corporation, Pleasanton, CA). Currently, patient is in the ICU on ventilator support and stable on vasopressin 0.02 units/min, milrinone 0.5 mcg/kg/min, and amiodarone. His mean arterial pressure is 77 mmHg and his heart rate is 110 bpm. He is making urine with a Cr of 1.2 mg/dL (baseline 1.5), ALT 33, INR 1.1. |
| Scenario C | 56 year old male with chronic nonischemic heart failure (EF <10%) admitted with 20 pound weight gain, nausea and vomiting with SBP 83/68 and HR 120 bpm. He is on 100 mg daily torsemide at home. First admit in a year. Not on home inotropes. Currently, patient is in the ICU on an intraaortic balloon pump on vasopressin 0.04 units/min, milrinone 0.5 mcg/kg/min, dobutamine 5 mcg/kg/min and levophed 12 mcg/min. His blood pressure is 85/65 mmHg and his heart rate is 125 bpm. Swan numbers:, RA 14, PA 53/30, WP 27, CI 1.5. He is making urine with a lot of IV diuretics. Labs day of operation: Cr 1.7 mg/dL (1.0 is his baseline), His INR is 1.5 (no warfarin), ALT 100. He is NOT vented. |
| Scenario D | 56 year old male with chronic nonischemic systolic heart failure admitted from clinic with NYHA class IIIb–IV symptoms and 20 pound weight gain on 100 mg torsemide. Baseline Cr 1.0 increasing to 1.5 mg/dL on admission. Currently in the ICU on milrinone 0.5 mcg/kg/min and Lasix 15 mg/hr gtt. No pressors, IABP or ventilator. Labs on day of operation: ALT 90, INR 1.3, Cr 2.1. Swan on 0.5 mcg/kg/min milrinone: RA 20, PA 45/36, WP 32, CI 1.6 |
| Scenario E | 56 year old male with chronic nonischemic systolic heart failure admitted from home for scheduled VAD implant. Discharged 2 weeks ago after presenting with 20 pound weight gain on 100 mg torsemide with baseline Cr 1.4 peaking at 1.7 mg/dL on prior admission. NOT on home inotropes. 2nd admission in 6 months. Currently on the tele (nonICU) floor. Labs day of operation: ALT 20, INR 0.8, Cr 1.5. Admission swan numbers OFF milrinone: RA 11, PA 65/28, WP 27, CI 1.6. |
Abbreviations: ALT= alanine aminotransferase (IU/L), Cr=creatinine (mg/dL), ECMO=extracorporeal membrane oxygenation, IABP=intraaortic balloon pump, ICU= intensive care unit, NYHA= New York Heart Association, RA=right atrial pressure (mmHg), PA= pulmonary artery pressure (mmHg), WP= wedge pressure (mmHg), CI=cardiac index, (L/min/m2), SBP=systolic blood pressure (mmHg), HR=heart rate (beats per minute).