Flotrac is a monitoring platform that displays both intermittent and continuous hemodynamic measurements related to the assessment of the essential components of oxygen delivery as well as the balance of oxygen delivery against consumption
The document discusses the FloTrac system, which uses an existing arterial line to continuously monitor cardiac output (CO) and other hemodynamic values through advanced arterial waveform analysis. While the trends provided by FloTrac can be useful for estimating hemodynamic status, its specific CO and cardiac index values may not correlate exactly with pulmonary artery catheter measurements. FloTrac requires good arterial signal quality and its values could be affected by factors like arrhythmias, hemodynamic instability, or ventilator settings like PEEP. Clinical judgment is still needed to interpret the data from FloTrac.
This document discusses PiCCO (Pulse Contour Cardiac Output) monitoring. PiCCO enables assessment of a patient's hemodynamic status by measuring various volumetric and cardiac parameters. It requires a central venous pressure catheter and arterial line. PiCCO works by transpulmonary thermodilution, using cold saline injections to calculate volumes, and pulse contour analysis of the arterial waveform to provide continuous cardiac output monitoring. The document defines various parameters measured by PiCCO like preload, contractility, lung function, and afterload, and provides normal ranges. It also outlines indications, contraindications and the decision tree for hemodynamic monitoring using PiCCO.
This document discusses static and dynamic indices used for hemodynamic monitoring. Static indices like CVP and PAOP are poor predictors of fluid responsiveness. Only about 50% of critically ill patients are fluid responsive. Dynamic indices that measure the response of cardiac output to fluid challenges or changes in preload are better predictors. The passive leg raise test is a non-invasive dynamic index that can reliably assess fluid responsiveness. Dynamic monitoring allows for goal-directed fluid therapy to optimize cardiac preload while avoiding over-resuscitation.
comprehensive presentation on 2D echo use in ICu set up. helpful in finding causes of shock and also in monitoring of fluid status in critically ill patients.
Cardiac output monitoring provides important information about a patient's hemodynamic status. There are several invasive and non-invasive methods to measure cardiac output. Invasive methods include thermodilution, Fick method, lithium dilution. Thermodilution, using a pulmonary artery catheter, is considered the clinical gold standard but has fallen out of favor due to risks. Non-invasive options include esophageal Doppler, bioreactance, pulse contour analysis, and partial CO2 rebreathing. Choice of monitoring method depends on the patient's condition and goals of therapy.
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
Weaning from mechanical ventilation is the process of gradually transferring breathing from the ventilator to the patient. It must be individualized and involves assessing patient readiness using criteria like clinical stability, adequate oxygenation and pulmonary function. Weaning success means unassisted breathing for 48 hours after removal from the ventilator. Patients are classified as having simple, difficult or prolonged weaning based on time to successful extubation. Factors that can cause weaning failure include increased airway resistance, decreased lung compliance, and respiratory muscle fatigue due to conditions like cardiac dysfunction, diaphragm weakness or endocrine abnormalities.
Hemodynamic monitoring involves measuring a patient's circulatory status through various devices. Newer non-invasive devices like bioreactance and pulse contour analysis aim to continuously monitor cardiac output without needing a pulmonary artery catheter. Clinical trials show mixed results on whether advanced hemodynamic monitoring improves outcomes, but some evidence suggests it can reduce complications, length of hospital stay, and ventilation time in high-risk patients.
The document discusses the FloTrac system, which uses an existing arterial line to continuously monitor cardiac output (CO) and other hemodynamic values through advanced arterial waveform analysis. While the trends provided by FloTrac can be useful for estimating hemodynamic status, its specific CO and cardiac index values may not correlate exactly with pulmonary artery catheter measurements. FloTrac requires good arterial signal quality and its values could be affected by factors like arrhythmias, hemodynamic instability, or ventilator settings like PEEP. Clinical judgment is still needed to interpret the data from FloTrac.
This document discusses PiCCO (Pulse Contour Cardiac Output) monitoring. PiCCO enables assessment of a patient's hemodynamic status by measuring various volumetric and cardiac parameters. It requires a central venous pressure catheter and arterial line. PiCCO works by transpulmonary thermodilution, using cold saline injections to calculate volumes, and pulse contour analysis of the arterial waveform to provide continuous cardiac output monitoring. The document defines various parameters measured by PiCCO like preload, contractility, lung function, and afterload, and provides normal ranges. It also outlines indications, contraindications and the decision tree for hemodynamic monitoring using PiCCO.
This document discusses static and dynamic indices used for hemodynamic monitoring. Static indices like CVP and PAOP are poor predictors of fluid responsiveness. Only about 50% of critically ill patients are fluid responsive. Dynamic indices that measure the response of cardiac output to fluid challenges or changes in preload are better predictors. The passive leg raise test is a non-invasive dynamic index that can reliably assess fluid responsiveness. Dynamic monitoring allows for goal-directed fluid therapy to optimize cardiac preload while avoiding over-resuscitation.
comprehensive presentation on 2D echo use in ICu set up. helpful in finding causes of shock and also in monitoring of fluid status in critically ill patients.
Cardiac output monitoring provides important information about a patient's hemodynamic status. There are several invasive and non-invasive methods to measure cardiac output. Invasive methods include thermodilution, Fick method, lithium dilution. Thermodilution, using a pulmonary artery catheter, is considered the clinical gold standard but has fallen out of favor due to risks. Non-invasive options include esophageal Doppler, bioreactance, pulse contour analysis, and partial CO2 rebreathing. Choice of monitoring method depends on the patient's condition and goals of therapy.
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
Weaning from mechanical ventilation is the process of gradually transferring breathing from the ventilator to the patient. It must be individualized and involves assessing patient readiness using criteria like clinical stability, adequate oxygenation and pulmonary function. Weaning success means unassisted breathing for 48 hours after removal from the ventilator. Patients are classified as having simple, difficult or prolonged weaning based on time to successful extubation. Factors that can cause weaning failure include increased airway resistance, decreased lung compliance, and respiratory muscle fatigue due to conditions like cardiac dysfunction, diaphragm weakness or endocrine abnormalities.
Hemodynamic monitoring involves measuring a patient's circulatory status through various devices. Newer non-invasive devices like bioreactance and pulse contour analysis aim to continuously monitor cardiac output without needing a pulmonary artery catheter. Clinical trials show mixed results on whether advanced hemodynamic monitoring improves outcomes, but some evidence suggests it can reduce complications, length of hospital stay, and ventilation time in high-risk patients.
This document provides an overview of cardiopulmonary exercise testing (CPET) including:
1. CPET assesses the integrated exercise responses of multiple body systems.
2. It describes the equipment, protocols, measurements, and safety considerations for CPET.
3. The document explains how CPET can evaluate exercise limitation and provide diagnostic information for conditions like cardiomyopathy by measuring how the cardiopulmonary systems respond during exercise.
Cardiac output can be measured through various invasive and non-invasive methods. The pulmonary artery catheter using thermodilution is still considered the gold standard but is invasive. Minimally invasive methods include lithium dilution, pulse contour analysis devices, esophageal Doppler, and transesophageal echocardiography. Non-invasive methods include partial gas rebreathing, thoracic bioimpedance, and Doppler ultrasound. The ideal monitor is accurate, continuous, non-invasive and provides reliable measurements during different physiological states.
1. Mitral stenosis is most commonly caused by rheumatic fever and results in thickening and calcification of the mitral valve, reducing the valve orifice area and obstructing blood flow from the left atrium to ventricle.
2. The pathophysiology involves elevated left atrial pressure, pulmonary hypertension, and reduced cardiac output. Symptoms range from easy fatigability to pulmonary edema.
3. Physical exam findings include an opening snap, rumbling diastolic murmur, and signs of right heart failure in severe cases. Severity is graded based on orifice area, pulmonary artery pressure, and NYHA functional
The document discusses the history and development of pulmonary artery catheters. It describes how Dr. Swan and Dr. Ganz invented the balloon-tipped catheter and how it allows direct measurement of pressures in the heart and lungs. The document outlines the proper insertion technique and provides normal values for pressures measured in different areas of the heart and lungs. It also discusses indications, contraindications, and complications of pulmonary artery catheter use.
This document provides an overview of extracorporeal membrane oxygenation (ECMO), including its history, modes, components, indications, contraindications, and complications. ECMO is an effective technique for providing emergency circulatory and respiratory support. It works by draining venous blood, oxygenating it through an artificial lung, and returning it to the circulation. There are two main modes - venoarterial (VA) ECMO which supports both heart and lung function, and venovenous (VV) ECMO which only supports lung function. Proper anticoagulation, volume management, and treatment of potential complications like bleeding, infection and circuit failures are important for safe ECMO management.
This document provides information on the anaesthetic management of surgery for Tetralogy of Fallot (TOF). It describes the key anatomical features of TOF and its variants. It outlines the natural history of untreated TOF, including risks of cyanotic spells, heart failure and early death. The document discusses the goals of palliative and corrective surgeries, including the modified Blalock-Taussig shunt. It provides guidance on preoperative evaluation, intraoperative management and goals of anaesthesia to optimize hemodynamics and oxygenation during surgery.
This document discusses extracorporeal membrane oxygenation (ECMO), which provides prolonged cardiopulmonary support. There are two main types of ECMO: venovenous (VV) ECMO, which provides respiratory support, and venoarterial (VA) ECMO, which provides both respiratory and hemodynamic support. The document outlines patient selection criteria and outcomes, complications, techniques for initiation and maintenance of ECMO, and considerations for weaning from and discontinuing ECMO support.
This document discusses the relationship between heart and lung function and the interaction between intrathoracic pressures, lung volumes, and blood flow. It begins by explaining that the cardiovascular and pulmonary systems function to link metabolizing cells to oxygen sources. It then discusses how intrathoracic and intramural pressures impact blood flow through collapsible tubes based on principles of fluid dynamics. Changes in surrounding pressures, such as pleural or pericardial pressure, can impact lung volumes, cardiac preload and afterload, and venous return. Understanding these complex interactions is important for critical care.
The document discusses the use of high flow nasal cannula (HFNC) oxygen therapy. It presents findings from several studies that show HFNC can increase apnea times in patients with difficult airways, may reduce the need for intubation and improve mortality in abnormal lungs, and can reduce hypoxemia in ICU patients. However, one study found no difference in preoxygenation when comparing HFNC to a face mask. The document recommends using HFNC in the ED for comfort in patients with hypoxia/respiratory distress, for apneic oxygenation during brief procedures in those at risk, and for mild respiratory distress and hypoxia where intubation and NIV may not be needed.
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
This document discusses various types of tachyarrhythmias categorized by their anatomical location and electrophysiological mechanisms. It describes atrial arrhythmias including sinus tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. It also discusses atrioventricular node reentrant tachycardia, atrioventricular reentrant tachycardia, junctional tachycardia, and ventricular arrhythmias including monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. Key features and mechanisms of each type are outlined to aid in diagnosis and classification.
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
This document discusses various methods for monitoring the central nervous system (CNS) during and after surgery. It describes cerebral perfusion monitoring techniques like cerebral blood flow measurements, transcranial Doppler ultrasonography, near-infrared spectroscopy, and jugular bulb oximetry. Regional perfusion is also monitored using brain tissue partial oxygen tension. Cerebral metabolism is assessed using cerebral microdialysis. Cerebral function is evaluated with the bispectral index, approximate entropy, and auditory evoked potentials. The document provides details on how each technique is performed and what insights it provides about CNS oxygenation, blood flow, and electrical activity.
1. Clinical examination alone is not sufficient to assess hemodynamic status in critically ill patients as individual vital signs do not reflect overall status.
2. Arterial lines can be used to monitor blood pressure, heart rate, and derive parameters like cardiac output but waveforms require interpretation and may be affected by various artifacts.
3. Pulmonary artery catheters can measure central venous and pulmonary artery pressures as well as cardiac output but have potential complications and their use remains controversial with no proven benefits shown in large trials.
BLS(basic life support) & ACLS with PALS by Dr. ShailendraShailendra Satpute
This document provides information on Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). It defines cardiac arrest, outlines its causes and types including ventricular fibrillation, pulseless ventricular tachycardia, asystole, and pulseless electrical activity. It describes the signs and symptoms of cardiac arrest. It also summarizes the steps of BLS including chest compressions, airway management, rescue breathing, and defibrillation. Advanced techniques like intubation, use of laryngeal mask airways, endotracheal tubes, and automated external defibrillators are also outlined.
Recruitment Maneuvers in ARDS Dr Chennamchetty Vijay KumarVizae Kumar Chennam
This document discusses recruitment maneuvers for mechanically ventilated patients. It begins with a case study of a patient presenting with respiratory failure. It then provides definitions and the physiological rationale for recruitment maneuvers, including how alveolar collapse occurs in ARDS. Different types of recruitment maneuvers are described, as well as factors that influence their effectiveness. Clinical trials on recruitment maneuvers are summarized, which found no significant reduction in mortality but some improvement in secondary outcomes. Limitations of recruitment maneuvers are discussed, such as potential hemodynamic effects. The document concludes with emphasizing the complexity of lung recruitment and ongoing controversies regarding recruitment maneuvers.
This document discusses perioperative dysrhythmias. It begins by defining dysrhythmias and noting they represent an important cause of complications during surgery. While most are benign, some can be lethal or symptomatic. The document then discusses the incidence, which is seen in 70.2% of patients undergoing general anesthesia and varies depending on surgery type and monitoring. It provides details on the mechanisms, causes, and types of perioperative dysrhythmias, as well as their presentation, treatment, and contributing risk factors.
This document summarizes different methods for measuring cardiac output, including clinical assessment, minimally invasive techniques, and invasive pulmonary artery catheterization. Clinical assessment involves evaluating end organ perfusion rather than direct cardiac output measurements. Minimally invasive techniques discussed include thoracic bioimpedance and esophageal Doppler. Invasive pulmonary artery catheterization provides direct cardiac output measurements via thermodilution but carries risks of complications. The document evaluates the advantages, limitations, and evidence for various cardiac output monitoring methods.
Anesthesia awareness occurs when a patient becomes conscious during a surgical procedure performed under general anesthesia and has recall of events. The incidence is 0.1-0.2% but higher for certain procedures like cardiac surgery. Patients at risk include women, those under 60, long surgeries, and prior awareness. Causes include light anesthesia, increased anesthetic requirements, and equipment errors. Patients commonly recall sounds and paralysis. Aftereffects may include PTSD. Prevention strategies include preoperative evaluation, proper equipment use, and intraoperative monitoring like BIS monitoring to maintain anesthesia levels.
The document provides an overview of the PiCCO measurement available on Philips IntelliVue patient monitors. PiCCO uses transpulmonary thermodilution and arterial pulse contour analysis to measure cardiac output and other hemodynamic parameters. It can measure cardiac index, volumes like global end-diastolic volume index, extravascular lung water index, and can provide continuous monitoring of parameters like continuous cardiac index. The document reviews the PiCCO method, normal ranges, and how it is implemented on IntelliVue monitors.
This document provides an overview of hemodynamic monitoring. It discusses various techniques for measuring pressure, including invasive arterial blood pressure monitoring and central venous pressure. Cardiac output can be monitored invasively using thermodilution or dye dilution, or noninvasively using pulse contour analysis. Volume status and fluid responsiveness can be assessed by measuring variables affected by preload such as pulse pressure variation. Tissue perfusion can be evaluated using near-infrared spectroscopy to measure tissue oxygen saturation or by analyzing lactate levels. The goal of hemodynamic monitoring is to achieve adequate organ perfusion while minimizing interventions, requiring use of multiple monitoring tools and integrating clinical findings.
This document provides an overview of cardiopulmonary exercise testing (CPET) including:
1. CPET assesses the integrated exercise responses of multiple body systems.
2. It describes the equipment, protocols, measurements, and safety considerations for CPET.
3. The document explains how CPET can evaluate exercise limitation and provide diagnostic information for conditions like cardiomyopathy by measuring how the cardiopulmonary systems respond during exercise.
Cardiac output can be measured through various invasive and non-invasive methods. The pulmonary artery catheter using thermodilution is still considered the gold standard but is invasive. Minimally invasive methods include lithium dilution, pulse contour analysis devices, esophageal Doppler, and transesophageal echocardiography. Non-invasive methods include partial gas rebreathing, thoracic bioimpedance, and Doppler ultrasound. The ideal monitor is accurate, continuous, non-invasive and provides reliable measurements during different physiological states.
1. Mitral stenosis is most commonly caused by rheumatic fever and results in thickening and calcification of the mitral valve, reducing the valve orifice area and obstructing blood flow from the left atrium to ventricle.
2. The pathophysiology involves elevated left atrial pressure, pulmonary hypertension, and reduced cardiac output. Symptoms range from easy fatigability to pulmonary edema.
3. Physical exam findings include an opening snap, rumbling diastolic murmur, and signs of right heart failure in severe cases. Severity is graded based on orifice area, pulmonary artery pressure, and NYHA functional
The document discusses the history and development of pulmonary artery catheters. It describes how Dr. Swan and Dr. Ganz invented the balloon-tipped catheter and how it allows direct measurement of pressures in the heart and lungs. The document outlines the proper insertion technique and provides normal values for pressures measured in different areas of the heart and lungs. It also discusses indications, contraindications, and complications of pulmonary artery catheter use.
This document provides an overview of extracorporeal membrane oxygenation (ECMO), including its history, modes, components, indications, contraindications, and complications. ECMO is an effective technique for providing emergency circulatory and respiratory support. It works by draining venous blood, oxygenating it through an artificial lung, and returning it to the circulation. There are two main modes - venoarterial (VA) ECMO which supports both heart and lung function, and venovenous (VV) ECMO which only supports lung function. Proper anticoagulation, volume management, and treatment of potential complications like bleeding, infection and circuit failures are important for safe ECMO management.
This document provides information on the anaesthetic management of surgery for Tetralogy of Fallot (TOF). It describes the key anatomical features of TOF and its variants. It outlines the natural history of untreated TOF, including risks of cyanotic spells, heart failure and early death. The document discusses the goals of palliative and corrective surgeries, including the modified Blalock-Taussig shunt. It provides guidance on preoperative evaluation, intraoperative management and goals of anaesthesia to optimize hemodynamics and oxygenation during surgery.
This document discusses extracorporeal membrane oxygenation (ECMO), which provides prolonged cardiopulmonary support. There are two main types of ECMO: venovenous (VV) ECMO, which provides respiratory support, and venoarterial (VA) ECMO, which provides both respiratory and hemodynamic support. The document outlines patient selection criteria and outcomes, complications, techniques for initiation and maintenance of ECMO, and considerations for weaning from and discontinuing ECMO support.
This document discusses the relationship between heart and lung function and the interaction between intrathoracic pressures, lung volumes, and blood flow. It begins by explaining that the cardiovascular and pulmonary systems function to link metabolizing cells to oxygen sources. It then discusses how intrathoracic and intramural pressures impact blood flow through collapsible tubes based on principles of fluid dynamics. Changes in surrounding pressures, such as pleural or pericardial pressure, can impact lung volumes, cardiac preload and afterload, and venous return. Understanding these complex interactions is important for critical care.
The document discusses the use of high flow nasal cannula (HFNC) oxygen therapy. It presents findings from several studies that show HFNC can increase apnea times in patients with difficult airways, may reduce the need for intubation and improve mortality in abnormal lungs, and can reduce hypoxemia in ICU patients. However, one study found no difference in preoxygenation when comparing HFNC to a face mask. The document recommends using HFNC in the ED for comfort in patients with hypoxia/respiratory distress, for apneic oxygenation during brief procedures in those at risk, and for mild respiratory distress and hypoxia where intubation and NIV may not be needed.
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
This document discusses various types of tachyarrhythmias categorized by their anatomical location and electrophysiological mechanisms. It describes atrial arrhythmias including sinus tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. It also discusses atrioventricular node reentrant tachycardia, atrioventricular reentrant tachycardia, junctional tachycardia, and ventricular arrhythmias including monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. Key features and mechanisms of each type are outlined to aid in diagnosis and classification.
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
This document discusses various methods for monitoring the central nervous system (CNS) during and after surgery. It describes cerebral perfusion monitoring techniques like cerebral blood flow measurements, transcranial Doppler ultrasonography, near-infrared spectroscopy, and jugular bulb oximetry. Regional perfusion is also monitored using brain tissue partial oxygen tension. Cerebral metabolism is assessed using cerebral microdialysis. Cerebral function is evaluated with the bispectral index, approximate entropy, and auditory evoked potentials. The document provides details on how each technique is performed and what insights it provides about CNS oxygenation, blood flow, and electrical activity.
1. Clinical examination alone is not sufficient to assess hemodynamic status in critically ill patients as individual vital signs do not reflect overall status.
2. Arterial lines can be used to monitor blood pressure, heart rate, and derive parameters like cardiac output but waveforms require interpretation and may be affected by various artifacts.
3. Pulmonary artery catheters can measure central venous and pulmonary artery pressures as well as cardiac output but have potential complications and their use remains controversial with no proven benefits shown in large trials.
BLS(basic life support) & ACLS with PALS by Dr. ShailendraShailendra Satpute
This document provides information on Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). It defines cardiac arrest, outlines its causes and types including ventricular fibrillation, pulseless ventricular tachycardia, asystole, and pulseless electrical activity. It describes the signs and symptoms of cardiac arrest. It also summarizes the steps of BLS including chest compressions, airway management, rescue breathing, and defibrillation. Advanced techniques like intubation, use of laryngeal mask airways, endotracheal tubes, and automated external defibrillators are also outlined.
Recruitment Maneuvers in ARDS Dr Chennamchetty Vijay KumarVizae Kumar Chennam
This document discusses recruitment maneuvers for mechanically ventilated patients. It begins with a case study of a patient presenting with respiratory failure. It then provides definitions and the physiological rationale for recruitment maneuvers, including how alveolar collapse occurs in ARDS. Different types of recruitment maneuvers are described, as well as factors that influence their effectiveness. Clinical trials on recruitment maneuvers are summarized, which found no significant reduction in mortality but some improvement in secondary outcomes. Limitations of recruitment maneuvers are discussed, such as potential hemodynamic effects. The document concludes with emphasizing the complexity of lung recruitment and ongoing controversies regarding recruitment maneuvers.
This document discusses perioperative dysrhythmias. It begins by defining dysrhythmias and noting they represent an important cause of complications during surgery. While most are benign, some can be lethal or symptomatic. The document then discusses the incidence, which is seen in 70.2% of patients undergoing general anesthesia and varies depending on surgery type and monitoring. It provides details on the mechanisms, causes, and types of perioperative dysrhythmias, as well as their presentation, treatment, and contributing risk factors.
This document summarizes different methods for measuring cardiac output, including clinical assessment, minimally invasive techniques, and invasive pulmonary artery catheterization. Clinical assessment involves evaluating end organ perfusion rather than direct cardiac output measurements. Minimally invasive techniques discussed include thoracic bioimpedance and esophageal Doppler. Invasive pulmonary artery catheterization provides direct cardiac output measurements via thermodilution but carries risks of complications. The document evaluates the advantages, limitations, and evidence for various cardiac output monitoring methods.
Anesthesia awareness occurs when a patient becomes conscious during a surgical procedure performed under general anesthesia and has recall of events. The incidence is 0.1-0.2% but higher for certain procedures like cardiac surgery. Patients at risk include women, those under 60, long surgeries, and prior awareness. Causes include light anesthesia, increased anesthetic requirements, and equipment errors. Patients commonly recall sounds and paralysis. Aftereffects may include PTSD. Prevention strategies include preoperative evaluation, proper equipment use, and intraoperative monitoring like BIS monitoring to maintain anesthesia levels.
The document provides an overview of the PiCCO measurement available on Philips IntelliVue patient monitors. PiCCO uses transpulmonary thermodilution and arterial pulse contour analysis to measure cardiac output and other hemodynamic parameters. It can measure cardiac index, volumes like global end-diastolic volume index, extravascular lung water index, and can provide continuous monitoring of parameters like continuous cardiac index. The document reviews the PiCCO method, normal ranges, and how it is implemented on IntelliVue monitors.
This document provides an overview of hemodynamic monitoring. It discusses various techniques for measuring pressure, including invasive arterial blood pressure monitoring and central venous pressure. Cardiac output can be monitored invasively using thermodilution or dye dilution, or noninvasively using pulse contour analysis. Volume status and fluid responsiveness can be assessed by measuring variables affected by preload such as pulse pressure variation. Tissue perfusion can be evaluated using near-infrared spectroscopy to measure tissue oxygen saturation or by analyzing lactate levels. The goal of hemodynamic monitoring is to achieve adequate organ perfusion while minimizing interventions, requiring use of multiple monitoring tools and integrating clinical findings.
Hemodynamic monitoring involves measuring various cardiovascular parameters at the bedside, including blood pressures, heart rate, cardiac output, and volumes. It provides important information to guide treatment for critically ill patients. The document discusses several hemodynamic monitoring methods and parameters in detail, such as arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery pressure monitoring using catheters and transducers. It also covers topics like indications for hemodynamic monitoring, potential complications, and nursing considerations.
The USCOM 1A is a non-invasive device for accurate measurement and monitoring of circulation. USCOM allows simple measurement of preload, contractility and afterload for goal direction of therapy, and accurate monitoring of post intervention changes, taking advanced haemodynamics beyond the ICU.
USCOM The measure of life!
Hemodynamic monitoring of critically ill patientsV4Veeru25
Hemodynamic monitoring measures blood pressure, blood flow, and oxygen levels in the veins, heart, and arteries to provide information about a patient's circulation, perfusion, and organ oxygenation. It can be done invasively, using catheters in arteries or veins to directly measure pressures, or non-invasively using tools like a blood pressure cuff. Common invasive monitors include arterial lines, central venous pressure monitors, and pulmonary artery catheters. Precise readings and interpretations along with nursing care of lines and dressings are important for effective hemodynamic monitoring of critically ill patients.
1) Bioreactance and non-invasive arterial pressure curve analysis require more validation, especially in critically ill patients.
2) Non-calibrated pulse contour analysis is unreliable in critically ill patients receiving vasopressors.
3) Transpulmonary thermodilution devices using techniques like PiCCO can provide valuable information to clinical questions regarding shock such as fluid management and contractility through measurements of extravascular lung water, pulmonary vascular permeability index, and cardiac function index.
Monitoring of physiologic variables is an integral part of caring for critically ill patients. Debate exists regarding the usefulness and safety of invasive hemodynamic monitoring in the intensive care unit. Several studies have shown improved outcomes with hemodynamic monitoring in high-risk surgical patients, but evidence is conflicting for medical patients. PiCCO monitoring combines transpulmonary thermodilution and pulse contour analysis to continuously measure cardiac output and other hemodynamic parameters noninvasively. It provides useful information to guide fluid management and assess fluid responsiveness.
This document discusses cardiac output and continuous cardiac output measurement techniques. It describes how cardiac output is measured using a Swan-Ganz catheter via the thermodilution method, injecting cold saline and measuring the temperature change in the pulmonary artery. Continuous cardiac output can be measured minimally invasively using the PiCCO system, which uses a central venous catheter and femoral arterial catheter to inject cold saline and measure the temperature change, allowing beat-to-beat cardiac output monitoring. The document outlines the equipment, accessories, measurement procedures, and parameters provided by both methods.
Central venous pressure (CVP) is measured using an indwelling central venous catheter and manometer or transducer. CVP provides information about circulating blood volume and cardiac function. Normal CVP is 5-10 cm H2O. CVP is commonly measured in intensive care to guide fluid management in critically ill patients. Potential complications include infection, hemorrhage, catheter occlusion or displacement. Accurate CVP measurement requires proper patient positioning and use of manometers or transducers at the phlebostatic axis.
Spirometry is a test used to assess lung function by measuring airflow. It can help diagnose obstructive lung diseases like COPD and asthma by measuring airflow limitation through values like FEV1 and FEV1/FVC ratio. A spirometry report provides values for volumes of air inhaled and exhaled that are compared to predicted normal values to identify restrictive or obstructive lung abnormalities. Quality control measures ensure accurate spirometry administration and interpretation.
The document discusses various methods of clinical hemodynamic monitoring in the intensive care unit (ICU), including arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery pressure monitoring. It provides details on the indications, equipment, techniques, waveforms, and complications of invasive hemodynamic monitoring procedures like arterial line placement and central venous catheterization.
The study evaluated the ability of the third-generation FloTrac/Vigileo device to track changes in cardiac index (CI) induced by volume expansion or changes in norepinephrine dose in critically ill patients. The device showed moderate accuracy in tracking CI changes from volume expansion, but poor reliability for changes from norepinephrine titration. Specifically, changes in CI measured by the device (CIpw) correlated moderately with changes measured by thermodilution (CItd) for volume expansion but correlated poorly for norepinephrine changes. The ability of the device to track CI changes correlated inversely with changes in systemic vascular resistance.
This document discusses hemodynamic monitoring techniques to guide treatment for patients with hemodynamic failure. It describes using the PiCCO device to noninvasively monitor parameters such as cardiac output, lung water content, contractility, and fluid responsiveness to determine whether a patient needs vasopressors, volume expansion, inotropes, and when to stop fluid administration. Tests like pulse pressure variation, end-expiratory occlusion, and passive leg raising used with continuous cardiac output monitoring can predict fluid responsiveness, while extravascular lung water and pulmonary vascular permeability index measurements help avoid excessive fluid loading and lung injury.
This document provides an introduction to hemodynamic monitoring, which involves measuring factors that influence blood flow and pressure. It defines hemodynamic monitoring and outlines its purposes, which include diagnosing and managing shock states, determining fluid status, and measuring cardiac output. The document discusses indications for hemodynamic monitoring as well as contraindications for invasive pulmonary artery catheters. It also reviews important hemodynamic values and concepts, pulmonary artery catheter insertion and positioning, waveform analysis, and removal of pulmonary artery catheters.
This document discusses less invasive methods of advanced hemodynamic monitoring. It begins by explaining the key factors that affect hemodynamic conditions like cardiac output, including heart rate, intravascular volume, myocardial contraction, and vasoactivity. It then discusses several noninvasive and invasive monitoring methods and focuses on pulse wave contour analysis and transpulmonary thermodilution techniques. These techniques can provide continuous cardiac output measurements along with volumetric parameters through advanced analysis of arterial pressure waveforms and thermal dilution curves. The document concludes by outlining typical values of parameters measured and providing an example decision tree for fluid and drug therapy guided by hemodynamic monitoring.
This document provides information about a seminar on hemodynamic monitoring presented by UMAdevi.k. It discusses the purpose of hemodynamic monitoring in critically ill patients, which is to continuously assess the cardiovascular system and diagnose/manage complex medical conditions. Specific techniques covered include arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter pressure monitoring. Key aspects of each technique like indications, equipment, procedures, nursing responsibilities, and potential complications are defined. Normal hemodynamic values are also provided.
Basic and advanced Cardiovascular monitoring.pptxamitkalirawana07
This document provides an overview of cardiovascular monitoring techniques. It discusses the history and fundamentals of clinical monitoring including inspection, palpation, auscultation, and monitoring of heart rate, blood pressure, central venous pressure, and cardiac output. Both non-invasive and invasive methods are covered, such as pulmonary artery catheterization and thermodilution techniques. The advantages and limitations of different monitoring methods are also summarized.
1. The document discusses various questions about how the Starling device measures stroke volume variation, cardiac output, and other hemodynamic parameters noninvasively using bioreactance technology.
2. It provides details on studies that have validated Starling against invasive hemodynamic monitoring techniques. Starling can be used in various clinical settings such as the operating room and intensive care.
3. The document addresses limitations and appropriate use of the Starling device and sensors. It clarifies differences between bioreactance and bioimpedance technologies.
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End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath. ETCO2 levels reflect the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
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TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
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Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
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2. Introduction
Flotrac is a monitoring platform that displays both intermittent and
continuous hemodynamic measurements related to the assessment of the
essential components of oxygen delivery as well as the balance of oxygen
delivery against consumption .
The monitor uses the patient's arterial pressure waveform to continuously
measure cardiac output and stroke volume .
Automatically updates advanced parameters every 20 seconds, reflecting
rapid physical changes in moderate to high-risk surgery.
3. The continuous parametric measurements provided from an arterial
line via an Edwards CO sensor include cardiac output (CO), stroke
volume (SV), and stroke volume variation (SVV).
The intermittent parametric measurements require use of a
VolumeView catheter in a femoral artery, a CVC (central venous
catheter) thermistor manifold, and a central venous pressure
measurement.
The intermittent parameters include:
cardiac output (iCO)
stroke volume (iSV),
systemic vascular resistance (iSVR)
global end-diastolic volume (GEDV)
extravascular lung water (EVLW)
4. Mechanism of work
The monitor uses the patient’s arterial pressure waveform to continuously
measure cardiac output.
With inputs of height, weight, age and gender, patient-specific vascular
compliance is determined .
5. Flo Trac sensor
It is a sterile , single use kit that monitors pressures when attached to
pressure monitoring cathetars . it has a straight , flow through design
across the pressure sensors with an integral flush device .
Easily setup and calibrated at the bedside using the familiar skills used in
pressure monitoring .
It measures the variations of the arterial pressure which is proportional to
stroke volume.
9. The Physiology screen displays monitored parameters using a visual
representation of the heart, lungs and circulatory system and their
relevant measured volume .
The lungs appear gray in continuous mode to indicate that no
information is available for extravascular lung water.
In the Screen the image of the beating heart is a visual
representation of the pulse rate .
10.
11. Big Numbers Screen
The screen displays parameters in a larger size than the other screens. This makes it
easier for clinicians and other personnel to see the values from a distance .
12. Cockpit Screen
This monitoring screen displays globes with the values of the parameter being monitored. They
graphically indicate target, out of range and target values with needle indicators to show where the
patient’s parameter falls .
14. Indications
Use primarily for critical care patients in which the balance between cardiac
function, fluid status and vascular resistance needs continuous or
intermittent assessment
Assess Extra Vascular Lung Water (EVLW) as an indicator of pulmonary
edema
15. The first image shows low pulmonary edema, the second
shows moderate pulmonary edema, and the third shows
severe pulmonary edema
16. FloTrac Continuous Parameters
Cardiac output (CO) - Continuous assessment of the volume of blood
pumped by the heart measured in liters per minute.
Cardiac Index (CI) Cardiac output relative to body surface area (BSA).
Stroke Volume (SV) Volume of blood pumped with each heart beat.
Stroke Volume Index (SVI) Stroke volume relative to body surface
area (BSA).
17. Systemic Vascular Resistance (SVR) The resistance that the left
ventricle must overcome to eject stroke volume with each beat .
Systemic Vascular Resistance Index (SVRI) SVR relative to body
surface area.
Stroke Volume Variation (SVV) The percent difference between
SVmin, max and mean
18. Initial Startup
Connect the primed FloTrac sensor to the Databox.
Connect the primed FloTrac pressure tubing to the radial or femoral arterial catheter and
primed central venous pressure tubing to the CVC catheter if continuous SVR/ SVRI
monitoring is desired .
Patient data can be entered by touching the Settings button.
Touch Patient Data and then touch each field to enter or select the patient demographic
data.
Touch the Home button. Touch the Monitor Screen Selection button and then select the
desired monitoring screen
19. Zeroing of FloTrac for continuous monitoring :
Level the transducer and sensor to the patient’s phlebostatic axis.
Touch the Clinical Actions button.
21. Zero each transducer by touching -0- next to the pressure or -0- All
to zero both.
Open transducers so they are “ON” to the patient and confirm
appropriate waveforms
Touch the Home button to begin monitoring
23. Volume View Intermittent TPTD Monitoring
Trans pulmonary thermodilution (TPTD) measures parameters related to
blood flow, fluid volume, and organ function .
It is measured when an indicator solution of known temperature and volume
is injected into the central venous circulation.
It then passes through the pulmonary vascular system, the left heart, and
finally into the arterial system .
24. Volume View Intermittent TPTD Parameters
Cardiac Function Index (CFI) is provided by transpulmonary thermodilution and serves
as an indicator of left ventricular systolic function .
Cardiac output (iCO) Intermittent assessment through thermodilution of the volume of
blood pumped by the heart measured in liters per minute .
Extravascular Lung Water (EVLW) Extravascular water content of the lung tissue.
Extravascular Lung Water Index (ELWI) Extravascular water content of the lung tissue
relative to predicted body weight (PBW) .
Global Ejection Fraction (GEF) Estimated ejection fraction using GEDV.
25. Cont.….
Global End-Diastolic Volume (GEDV) Estimated combined volume of the RAEDV,
RVEDV, LAEDV, and LVEDV.
Global End-Diastolic Volume Index (GEDI) Estimated combined volume of the RAEDV,
RVEDV, LAEDV, and LVEDV relative to body surface Area .
Intrathoracic Blood Volume (ITBV) Estimated combined volume of the heart and the
pulmonary blood volume (PBV).
Pulmonary Vascular Permeability Index (PVPI) Ratio of the extravascular lung water
and the estimated volume of pulmonary blood .
26.
27.
28. Articles required
A Tray containing :
Flo trac and tubings
Sterile gloves
20 cc syringe
Cold saline
Pressure Bag
Volume View femoral artery catheter
Volume View sensor
Central Venous catheter
Volume View Manifold
TruWave disposable pressure transducer (CVP transducer)
29. Procedure
Insert the VolumeView femoral arterial catheter and Insert a CVC).
Ensure the TruWave central venous pressure transducer and VolumeView sensor are primed and
then connected to the EV1000 databox.
Ensure the sensor and transducer are level to patient’s phlebostatic axis and zero transducers on
monitor using Clinical Actions button.
Connect the VolumeView sensor to the VolumeView femoral arterial catheter and confirm the
appropriate waveforms and pressures are displayed .
Connect the databox thermistor cable to the VolumeView femoral arterial thermistor and confirm
appropriate temperature on the EV1000 monitor.
30. Procedure
Connect a pre-chilled syringe with normal saline to the VolumeView
manifold valve/port connection
Touch the Clinical Actions button
31. Touch Thermodilution
Touch the button next to Injectate Volume and touch the desired
injectate volume (up to 20 mL) on the drop-down menu
32. Touch Start Set. Wait is highlighted. When the thermal baseline is
established you will see the Inject screen .
When Inject appears on the screen, use a rapid, smooth, continuous
method to inject the cold solution with the volume amount previously
selected .
33. If more measurements are required, replace with another pre-chilled
primed syringe
35. Advantages
Continuously computes stroke volume from the patient’s arterial pressure
signal .
Displays key hemodynamic parameters on a continuous basis (every 20
sec)
Requires NO manual calibration
The user simply enters patient age, gender, height and weight to initiate
monitoring
Advanced waveform analysis compensates for .
Patient-to-patient differences in vasculature
Real time changes in vascular tone
Differing arterial sites
36. Disadvantages
No absolute contraindications but has limitations that must be taken into
account.
The monitoring system is only recommended for patients that are 100%
mechanically ventilated and not spontaneously breathing.
38. Conclusion
FloTrac system - a minimally invasive solution system that provides
dynamic and flow-based hemodynamic parameters.
Uses Patients arterial waveform for analysis .
Automatically provides results every 20 secs .