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Cardiovascular Support in ICU

Cardiovascular Support in ICU . Dr ben harris. Objectives . Basic physiology (+small amount of biochemistry) Indications for CVS support Drugs used for CVS support. Some basic physiology. Cardiac output = ? Stroke volume x heart rate Stroke volume? Mean arterial pressure = ?

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Cardiovascular Support in ICU

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  1. Cardiovascular Support in ICU Dr ben harris

  2. Objectives • Basic physiology (+small amount of biochemistry) • Indications for CVS support • Drugs used for CVS support

  3. Some basic physiology • Cardiac output = ? • Stroke volume x heart rate • Stroke volume? • Mean arterial pressure = ? • Cardiac output x systemic vascular resistance • Diastolic BP + (1/3 systolic BP – diastolic BP) • Oxygen Delivery • Cardiac output x oxygen content (1.34 x SaO2 x Hb)

  4. MAP Stroke volume Heart rate Systemic Vascular Resistance

  5. MAP and CO

  6. MAP and SVR β1 Inotropy / Chronotropy β2 Vasodilation ⍺1 Vasoconstriction

  7. Shock Hypovolaemic Cardiogenic Septic Anaphylactic Neurogenic

  8. Shock

  9. Clinical Signs of Shock • Confusion • Delirium • Tachycardia • Hypotension • ⬆ CRT • Tachypnoea • Cool / Clammy • Warm / sweaty • Oliguria • Metabolic acidosis

  10. Lactate

  11. Anaesthesia

  12. Anaesthesia

  13. CVS Support • Optimise circulating volume • Fluids • Blood products in massive haemorrhage • Optimise other physiology

  14. CVS Support • Non-catecholamines • Ephedrine • Metaraminol • Phenylephrine

  15. CVS Support • Catecholamines

  16. CVS Support • Catecholamines • Noradrenaline • Adrenaline • Dopamine / dobutamine

  17. CVS Support

  18. CVS Support • Vasopressin • Milrinone • Levosimendan

  19. Summary • MAP = CO x SVR • 5 types of shock • Peripheral vasopressors • Central Vasopressors • Noradrenaline  vasopressin  adrenaline

  20. References • Cardiovascular failure, inotropes and vasopressors. British Journal of Hospital Medicine, May 2012, Vol 73, No 5 • Basic Sciences, Update in Anaesthesia, December 2008, Vol 24, No 2 • Mean Arterial Pressure, http://www.cvphysiology.com/Blood%20Pressure/BP006

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