Hemodynamic Monitoring. Khaled O. Hadeli 12/7/99. DO2 = CO x 13.4 x Hb x SaO2 DO2 = (SV x HR) 13.4 x Hb x SaO2. MR. RVF. Hypovolemic shock. Acute bronchospasm. Busy Tracing. Cardiac performance CO/CI CVP/RAP/RVP/PAP/ Pcwp RVEF SVR/PVR. O2 transport parameters
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Khaled O. Hadeli
DO2 = CO x 13.4 x Hb x SaO2
DO2 = (SV x HR) 13.4 x Hb x SaO2
O2 transport parameters
THE WEDGE PRESSURE
CO=Amount of indicator injected / Area under the curve
Related to presence of the cath. In circulation
infarction <1 - 7%
artery rupture <1%
endocardial damage 35%
valve damage <1%
endocarditis 0 - 7%
Balloon rupture <4%
PGY1 2-3 4-6 Staff Expert
Iberti, JAMA 264:2928,1990
Significant improvement in mortality subsequent to the presence of CCM specialist in the ICU
despite increased use of PAC
Reynolds et. Al. JAMA1988:260;3446-50
Connors, JAMA 276;889,1996
*Dalen et.al. JAMA 1996:276;916-8
1,000,000 RHC every year
2 Billion Dollars / year(1990)*
*Shoemaker et al.
Mimoz et.al.CCM 1994;22:573-9
*Russell et a.
**Gattinoni/Hayes, NEJM 1995/1994
PAC, a diagnostic toll or a therapeutic modality?
In the critically ill patient hemodynamic monitoring is aimed to optimize which of the following?
A 65yr old male 4 days post-op developed sudden onset of fever, chills and SOB. Vitals show HR 130, BP 85/55 mmHg, RR40/min, PaO2 40mmHg.
He was intubated and given 500cc NS, started on vasoactive therapy, and referred to MICU.
Your immediate action should be:
A. give volume
C. leave volume status as is
And / Or
A. give more vasopressor therapy
B. Taper vasopressor therapy
C. leave vasoactive therapy as is
A searchlight cannot be used effectively without a fairly thorough knowledge of the territory to be searched.
Fergus Macartney, FRCP