Hemodynamic monitoring basic assessment

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Hemodynamic monitoring basic assessment

  1. 1. Hemodynamic Monitoring-Basic Assessment Steven Podnos MD
  2. 2. Pathophysiology <ul><li>Cardiac Output is function of Pump and Preload return of blood </li></ul><ul><li>Preload=Right Atrial pressure (CVP approximately). </li></ul><ul><li>Oxygen delivery is Cardiac Output X O2 Content </li></ul><ul><li>Measures that decrease cardiac output but increase O2 sat, may cancel each other out </li></ul>
  3. 3. Monitoring - Basics <ul><li>Look at the Patient-mental status, warm?, urine output </li></ul><ul><li>Labs-Base excess/lactate </li></ul>
  4. 4. Monitoring-Advanced <ul><li>Blood Pressure-did it drop with ventilator change? </li></ul><ul><li>CVP-does not necessarily indicate blood volume or fluid responsiveness </li></ul><ul><li>BUT, a low CVP means the patient is more likely to benefit from fluid if hemodynamically compromised </li></ul>
  5. 5. CVP <ul><li>May be normally low in normal individuals with normal blood volumes and cardiac output </li></ul><ul><li>High CVP can occur with fluid overload OR impaired cardiac function and volume depletion </li></ul><ul><li>Consider CVP and Cardiac Output (perfusion) at the same time </li></ul>
  6. 6. CVP use <ul><li>Consider fluid bolus in patient with CVP below 10 (assuming low BP and/or cardiac output) </li></ul><ul><li>Note that positive pressure ventilation/PEEP increases measured CVP (goal 8-12 without vent, 12-15 with vent) </li></ul><ul><li>Goal directed therapy improvements in survival using CVP to guide fluids in sepsis suggests efficacy </li></ul>
  7. 7. Dry? <ul><li>Several studies suggest that a conservative fluid strategy increases survival and minimizes acute lung injury-use CVP to guide fluid boluses only if evidence of hypo-perfusion </li></ul>
  8. 8. The method of using CVP monitors is simple: volume load until the patient reaches the target CVP and stays there.
  9. 10. Fluid Bolus Response <ul><li>Suggest enough fluid to increase CVP by 2mm </li></ul><ul><li>? Evidence of improved perfusion? </li></ul>

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