Hemodynamic Assessment and Invasive Monitoring. Kevin M. Creamer M.D. Pediatric Critical Care Walter Reed AMC. Introduction Hemodynamic Determinants & Assessment Monitoring Considerations A Cautionary Tale. Monitoring indications “Normal Values” Complications Hemodynamic scenarios.
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Kevin M. Creamer M.D.
Pediatric Critical Care
Walter Reed AMC
Fitzgerald, Br Med J, 1999
Its only algorithm: I must maintain CO!
Continuous HR, RR, Pulse ox, intermittent NIBP
Consider foley for any patient whose UOP is questionable or to monitor CO
Frequent sampling needs require either a large PIV, Art line or CVC
Some children who need reliable IV access may need a PIC or central lineMonitoring Indications
Newman, J Ped Surg, 1986
(MAP – CVP) / CO
(MPAP – PCWP) / CO
< 3 wo 120-130 ml/min/m2
> 3 wo 150-160 ml/min/m2
Salzman 1995 Adv. Ped. Inf., Odetola,CCM(A), 2001,
Dis,Luyt, S. Africa 1996, Smith-Wright, CCM, 1984
Maki, CCM(A),2001,Pierce, ICM,2000 Darouiche, NEJM, 1999
I’d humbly like to go back in time and try another approach