Learning power point presentation for Post graduate students / trainees in paediatrics/ Fellows in paediatric critical care/ Paediatric cardiology

1. Dr Isha Deshmukh
Assistant Professor Pediatrics
BJGMC & SGH, Pune

2. Cardiovascular assessment and monitoring
in PICU needs
Integration of physical examination
Chest radiography
Blood Pressure monitoring
Pulse oximetry

3. Sepsis
ARDS
Single ventricle physiology
Congestive cardiac failure
Left to right shunt
Eisenmingerization
Certain toxic myocarditis
Electrolyte disturbances

4. Diminished peripheral pulses
Cool or mottled extremities
Delayed capillary refilling time
Decreased diastolic pressure
Reduced Mean arterial pressure
Hypotension
Tachycardia
SVT/ Arrythmias

5. Valve clicks
Pericardial rubs
Gallop Rhythm
Intraparenchymal lung damage
Raised JVP
Bilateral crepitions, Pulmonary edema
High right sided filling pressures

6.  Assessment of heart size, contour and
configuration
 Pulmonary vascularity
 Pleural effusion
 Pericardial effusion
 Abdominal situs
 Increased or decreased pulmonary blood flow
 Fluffy hilam shadows
 Increased pulmonary venous markings

7. Positions of ET tube
Presence of fluid or air
CT ratio
Cardiomegaly
Left ventricular or right ventricular
enlargement
Constrictive pericarditis
Acute fulminant myocarditis
Acute pericardial tamponade

8. The Fick method
Thermodilution technique
Dye dilution method
Doppler Echocardiography

9. Use of specialized pulmonary artery catheter
CO = 1.08 X Vi (Tb – Ti )/ e0Tb (t)dt
Where Vi = injectate volume
Tb = temperature of blood
Ti = injectate temperature
Tb(t) = area under the curve

10. Fick principle
Cardiac output = O2 consumption / (Arterial
– venous O2 content )
The best site to obtain a mixed venous
sample is within the pulmonary artery .
Arteriovenous O2 difference is often used as
an indirect measure of CO

11. Mean velocity of systolic flow
Heart rate
Integrated flow velocity
Pulse oximetry
Measures quantity of hemoglobin saturated
with O2 in peripheral arterial blood.

12. Assessment of tissue hypoxia
Blood lactate concentration
Hydrogen ion concentration
Anion gap
Serum creatinine

13. Indirect assessment of perfusion by
measuring gut intramucosal pH or partial
pressure of carbon dioxide
Adds to continuous online measurement

14. Paediatric intravenous fluid therapy
measures
Oliguria
Reflects intravascular fluid status
Low SVR
Good measure of tissue perfusion

15. Assessment of systemic and regional
oxygen transport
Used in catheter based or surgical
interventions

16. Cardiac function Impact on QOT
Reduced ventricular systolic function Increased filling pressure , increased
ionotropic or pressor support
Reduced ventricular diastolic function Increased filling pressure, increased
pressor support
Abnormal rhythm Increased pressor / ionotropic support
Single ventricle with A P shunt Increased filling pressure
Intracardiac structural lesions Increased ionotropic or pressor
support

17. Increased SVR Inotropes increased, increased
ventricular work, increased
inotrophic support
Increased PVR Increased filling pressure , increased
ionotropic support
Decreased SVR Increased ventricular work, increased
filling pressure
Increased PVR Inotropes increased, increased
ventricular work, increased inotrophic
support
AP Shunt Reduced pulmonary blood flow
Bidirectional Shunt Increased SVC pressure
Fontan procedure Increased filling pressure, increased
ionotropic support

18. Vascular function
Leaky vascular bed or edema Increased filling pressures, increased
ionotropic support
Pulmonary function
Reduced lung compliance , reduced
gas exchange
Increased airway pressure, reduced
venos return, increased SVR ,
Barotrauma

19. Increased ventricular afterload
Increased Ventricular volume
Impaired ventricular filling
Reduced pulmonary blood flow with
shunting into systemic circulation
Mixing of pulmonary and systemic venous
blood
D – TGA
Impaired coronary perfusion

20. Third space loss
Ascites
Pleural or pericardial effusion
Abdominal compartment syndrome
High CVP
Improved pulmonary mechanics
Improved hydration and urine output

21. Pulmonary dysfunction
Ventilation perfusion mismatch
Positive end expiratory pressures
Impaired gas exchange
Persistent pulmonary hypertension
Increased PVR
Lung hyperinflation