Hemodynamics Lecture ARMC
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This document provides an overview of hemodynamic principles and invasive hemodynamic monitoring. It defines key terms like preload, afterload, contractility and discusses how they impact cardiac output. Specific monitoring tools like arterial lines, central venous pressure monitors and pulmonary artery catheters are explained. Treatment strategies to optimize cardiac output by manipulating heart rate, contractility, preload and afterload are outlined.
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Hemodynamics.kiran rai
The document discusses hemodynamics and cardiovascular physiology, including:
1) Components of the circulatory system like the heart chambers and blood vessels.
2) Hemodynamic principles such as cardiac output, stroke volume, preload, afterload, and contractility.
3) Monitoring of hemodynamics using tools like arterial lines, central venous pressure measurements, and pulmonary artery catheters.
Hemodynamics
Hemodynamics refers to the interrelationship of blood pressure, blood flow, vascular volumes, heart rate, and ventricular function. It can be measured non-invasively through vital signs and blood pressure measurements, or invasively through central venous pressure (CVP), pulmonary artery pressure (PAP), and intra-aortic balloon pump (IABP) measurements. CVP is commonly used to assess volume status and right ventricular function in critically ill patients, those undergoing major surgery or in shock. It is contraindicated in patients with coagulopathies, venous anomalies or thrombosis. Invasive hemodynamic monitoring carries risks of infection, bleeding, and organ injury that must be weighed against clinical benefits for individual patients.
Hemodynamics and Shock
Hemodynamic monitoring involves measuring and monitoring the factors that influence blood flow and pressure in the body. It is concerned with five main areas: the right heart, lungs, left heart, fluid status, and blood pressures. Normal hemodynamic values include a central venous pressure of 2-6 mmHg, pulmonary artery pressure of 6-15 mmHg, pulmonary capillary wedge pressure of 6-12 mmHg, and a cardiac output of 4-8 L/min. Treatment for different types of shock depends on the underlying cause but may include inotropes, vasopressors, antibiotics, and fluid resuscitation.
Hemodynamics presentation
The document discusses hemodynamic definitions and their indications for monitoring in respiratory patients. It defines terms like cardiac output, stroke volume, preload, afterload, contractility, right atrial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance, and pulmonary vascular resistance. Abnormal values of each parameter are provided, along with their clinical significance in assessing a patient's cardiovascular status.
The CVP in hypovolemic shock.
The CVP in patient with hypovolemic shock
case :
Mostafa 22years old
Agitated and compleaning of abdominal pain
Airway is patent
Respiratory rate 32 per min.
BP 90/60 mmHg.
Pulse 130 bpm.
Temp 36C.
Abdominal distension.
Cold skin
Nsogastric tube rvealed green liqued
Urinary cathetar revealed dark urine
Hemoglobin is 7.
FAST is postive.
Hemodynamic monitoring basic assessment
Cardiac output is determined by preload and pump function, where preload is approximated by right atrial or central venous pressure (CVP). While measures that decrease cardiac output but increase oxygen saturation may cancel each other out, CVP alone does not indicate blood volume or fluid responsiveness but a low CVP suggests a patient may benefit from fluid if hemodynamically compromised. CVP should be considered together with cardiac output to guide fluid administration, with a goal of 8-12 mmHg without ventilation or 12-15 mmHg with ventilation; however, a conservative fluid strategy may improve outcomes by minimizing acute lung injury.
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This document provides an overview of cardiovascular anatomy and physiology and hemodynamic monitoring. It discusses how the heart pumps oxygenated blood to tissues and deoxygenated blood to the lungs. Key points include:
- The left ventricle pumps oxygenated blood into systemic circulation and its function is important for distributing oxygen to organs.
- Cardiac output, stroke volume, heart rate, preload, afterload and contractility determine how much blood the heart pumps.
- Hemodynamic pressures like CVP, PAP and PCWP are measured to assess preload and afterload on the right and left ventricles.
New power point hemodynamic
This document discusses the use of hemodynamic monitoring to guide fluid administration and optimize stroke volume. It notes that physical exam signs are often inaccurate indicators of a patient's clinical status. Various methods for measuring stroke volume are presented, with esophageal Doppler monitoring found to be accurate, easy to use, and supported by evidence from randomized controlled trials showing it can reduce length of hospital stay. The document advocates using changes in stroke volume in response to fluids or medications to guide treatment to optimize preload and cardiac function.
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Hemodynamics.kiran rai
The document discusses hemodynamics and cardiovascular physiology, including:
1) Components of the circulatory system like the heart chambers and blood vessels.
2) Hemodynamic principles such as cardiac output, stroke volume, preload, afterload, and contractility.
3) Monitoring of hemodynamics using tools like arterial lines, central venous pressure measurements, and pulmonary artery catheters.
Hemodynamics
Hemodynamics refers to the interrelationship of blood pressure, blood flow, vascular volumes, heart rate, and ventricular function. It can be measured non-invasively through vital signs and blood pressure measurements, or invasively through central venous pressure (CVP), pulmonary artery pressure (PAP), and intra-aortic balloon pump (IABP) measurements. CVP is commonly used to assess volume status and right ventricular function in critically ill patients, those undergoing major surgery or in shock. It is contraindicated in patients with coagulopathies, venous anomalies or thrombosis. Invasive hemodynamic monitoring carries risks of infection, bleeding, and organ injury that must be weighed against clinical benefits for individual patients.
Hemodynamics and Shock
Hemodynamic monitoring involves measuring and monitoring the factors that influence blood flow and pressure in the body. It is concerned with five main areas: the right heart, lungs, left heart, fluid status, and blood pressures. Normal hemodynamic values include a central venous pressure of 2-6 mmHg, pulmonary artery pressure of 6-15 mmHg, pulmonary capillary wedge pressure of 6-12 mmHg, and a cardiac output of 4-8 L/min. Treatment for different types of shock depends on the underlying cause but may include inotropes, vasopressors, antibiotics, and fluid resuscitation.
Hemodynamics presentation
The document discusses hemodynamic definitions and their indications for monitoring in respiratory patients. It defines terms like cardiac output, stroke volume, preload, afterload, contractility, right atrial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance, and pulmonary vascular resistance. Abnormal values of each parameter are provided, along with their clinical significance in assessing a patient's cardiovascular status.
The CVP in hypovolemic shock.
The CVP in patient with hypovolemic shock
case :
Mostafa 22years old
Agitated and compleaning of abdominal pain
Airway is patent
Respiratory rate 32 per min.
BP 90/60 mmHg.
Pulse 130 bpm.
Temp 36C.
Abdominal distension.
Cold skin
Nsogastric tube rvealed green liqued
Urinary cathetar revealed dark urine
Hemoglobin is 7.
FAST is postive.
Hemodynamic monitoring basic assessment
Cardiac output is determined by preload and pump function, where preload is approximated by right atrial or central venous pressure (CVP). While measures that decrease cardiac output but increase oxygen saturation may cancel each other out, CVP alone does not indicate blood volume or fluid responsiveness but a low CVP suggests a patient may benefit from fluid if hemodynamically compromised. CVP should be considered together with cardiac output to guide fluid administration, with a goal of 8-12 mmHg without ventilation or 12-15 mmHg with ventilation; however, a conservative fluid strategy may improve outcomes by minimizing acute lung injury.
CARDIO VASCULAR HEMODYNAMICSLab[1]
This document provides an overview of cardiovascular anatomy and physiology and hemodynamic monitoring. It discusses how the heart pumps oxygenated blood to tissues and deoxygenated blood to the lungs. Key points include:
- The left ventricle pumps oxygenated blood into systemic circulation and its function is important for distributing oxygen to organs.
- Cardiac output, stroke volume, heart rate, preload, afterload and contractility determine how much blood the heart pumps.
- Hemodynamic pressures like CVP, PAP and PCWP are measured to assess preload and afterload on the right and left ventricles.
New power point hemodynamic
This document discusses the use of hemodynamic monitoring to guide fluid administration and optimize stroke volume. It notes that physical exam signs are often inaccurate indicators of a patient's clinical status. Various methods for measuring stroke volume are presented, with esophageal Doppler monitoring found to be accurate, easy to use, and supported by evidence from randomized controlled trials showing it can reduce length of hospital stay. The document advocates using changes in stroke volume in response to fluids or medications to guide treatment to optimize preload and cardiac function.
Blood pressure
Blood pressure is the pressure of blood in the arteries and is measured using a sphygmomanometer. It can be measured noninvasively using the auscultatory or oscillometry methods by wrapping a blood pressure cuff around the upper arm and listening or feeling for sounds. The systolic pressure is when the first sound is heard and diastolic is when the sounds disappear. Invasive methods involve direct measurement using a cannula placed in an artery.
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This document discusses blood pressure measurement and hypotension/hypertension. It provides details on:
- Accurately measuring blood pressure is important for assessing and managing hypotension and diagnosing/treating hypertension.
- Hypotension occurs when blood pressure is lower than usual, which can lead to inadequate blood flow. Postural hypotension is a type of hypotension that happens when changing positions.
- Hypertension is considered present if blood pressure is at or above 140/90 mmHg. Long-term high blood pressure can damage organs.
- The document outlines techniques for properly measuring blood pressure using a sphygmomanometer and stethoscope. Listening for Korotkoff sounds helps determine systolic
Cardiac output monitoring
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.
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Arterial pressure
The mean arterial pressure (MAP) is the average pressure in the arteries during one cardiac cycle and is a better indicator of tissue perfusion than systolic blood pressure. MAP is calculated based on cardiac output, systemic vascular resistance, and central venous pressure. Normal MAP is between 65-110 mmHg. Pulse wave velocity measures arterial stiffness and is influenced by arterial wall thickness and diameter. As pressure waves travel further from the heart, they become steeper and narrower due to vessel properties.
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II. Four goals of hemodynamic optimization are discussed: improving blood pressure, cardiac output, regional blood flow, and microcirculation. Dynamic parameters like stroke volume variation and passive leg raising can predict fluid responsiveness.
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1. The purpose of invasive hemodynamic monitoring is to detect and treat life-threatening conditions such as heart failure and cardiac tamponade by evaluating a patient's cardiovascular function and response to treatment.
2. Indications for hemodynamic monitoring include decreased cardiac output from various causes, shock, loss of cardiac function, and coronary artery disease.
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The document discusses factors that regulate cardiac output, including preload, contractility, and afterload. It describes how the respiratory pump, cardiac pump, muscle pump, and mean circulatory filling pressure affect cardiac output by changing preload. Sympathetic stimulation and hormones are discussed as factors increasing contractility. Methods for measuring cardiac output are also summarized, including the Fick principle, indicator dilution, thermodilution, Doppler echocardiography, and impedance cardiography. Cardiac output is increased in conditions like fever and anemia that cause increased metabolism, and decreased in states of weak contractions or poor pumping like congestive heart failure.
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Blood pressure is the pressure of blood in the arteries and is measured using a sphygmomanometer. It can be measured noninvasively using the auscultatory or oscillometry methods by wrapping a blood pressure cuff around the upper arm and listening or feeling for sounds. The systolic pressure is when the first sound is heard and diastolic is when the sounds disappear. Invasive methods involve direct measurement using a cannula placed in an artery.
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This document discusses blood pressure measurement and hypotension/hypertension. It provides details on:
- Accurately measuring blood pressure is important for assessing and managing hypotension and diagnosing/treating hypertension.
- Hypotension occurs when blood pressure is lower than usual, which can lead to inadequate blood flow. Postural hypotension is a type of hypotension that happens when changing positions.
- Hypertension is considered present if blood pressure is at or above 140/90 mmHg. Long-term high blood pressure can damage organs.
- The document outlines techniques for properly measuring blood pressure using a sphygmomanometer and stethoscope. Listening for Korotkoff sounds helps determine systolic
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The mean arterial pressure (MAP) is the average pressure in the arteries during one cardiac cycle and is a better indicator of tissue perfusion than systolic blood pressure. MAP is calculated based on cardiac output, systemic vascular resistance, and central venous pressure. Normal MAP is between 65-110 mmHg. Pulse wave velocity measures arterial stiffness and is influenced by arterial wall thickness and diameter. As pressure waves travel further from the heart, they become steeper and narrower due to vessel properties.
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This document discusses the basic cardiac physiology used to manage critically ill patients, including determinants of mean arterial pressure, cardiac output, and oxygen delivery. It describes how these concepts are used to diagnose different types of shock. Monitoring of central venous pressure is discussed as well as equations relating mean arterial pressure, stroke volume, heart rate, and systemic vascular resistance. The importance of oxygen delivery to tissues and maintaining an optimal venous oxygen saturation is emphasized.
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I. Dr. Badamali discusses hemodynamic monitoring of critically ill patients to improve outcomes. He outlines key equations related to cardiac output, oxygen delivery, and blood pressure.
II. Four goals of hemodynamic optimization are discussed: improving blood pressure, cardiac output, regional blood flow, and microcirculation. Dynamic parameters like stroke volume variation and passive leg raising can predict fluid responsiveness.
III. Evidence from studies like Rivers et al. show that early goal-directed therapy integrating hemodynamic monitoring into a treatment protocol can reduce mortality from sepsis. Goals must be part of an organized resuscitation and care program to successfully impact outcomes.
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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.
Assessment of shunt by cardiac catheterization
Cardiac catheterization is useful for assessing left-to-right shunts through three main techniques: oximetry runs to detect oxygen saturation step-ups, indicator dye dilution to detect early recirculation of dye injected into the proximal chamber, and angiocardiography to directly visualize the anatomic site of the shunt. While oximetry is best to localize the shunt, dye dilution can detect smaller shunts and angiography confirms anatomy. Together these techniques allow diagnosis and quantification of left-to-right intracardiac shunts.
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This slide will help the learners to know about the effect of postural change on blood pressure and heart rate. This method is very crucial in diagnosis of Postural Hypotension in subjects.
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Short term regulation occurs over seconds to minutes and involves baroreceptors, chemoreceptors, and the central nervous system ischemic response. Intermediate regulation over minutes to hours is mediated by capillary fluid shifts and stress relaxation in blood vessels. Long term regulation over days to years involves the renal body fluid mechanism and renin-angiotensin system to control extracellular fluid levels and blood pressure.
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2. Indications for hemodynamic monitoring include decreased cardiac output from various causes, shock, loss of cardiac function, and coronary artery disease.
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This document provides information on various bedside invasive procedures performed in critical care units, including arterial line placement, central venous catheter insertion, Swan-Ganz catheterization, pericardiocentesis, intra-aortic balloon counterpulsation, and temporary pacemaker insertion. Details are given on the indications, techniques, complications, and interpretations of findings for each procedure. Arterial and central lines are discussed in terms of cannulation sites, waveforms, and potential issues. Swan-Ganz catheters are described for measuring pressures in the right atrium, ventricle, and pulmonary artery to evaluate hemodynamics.
Hemodynamics
Hemodynamic monitoring measures factors that influence the force and flow of blood in order to aid in diagnosing, monitoring, and managing critically ill patients. It involves using pulmonary artery catheters and transducers to obtain pressures and other cardiovascular measurements that provide information on conditions like shock states and help guide treatment decisions. Potential risks and complications require careful use of these monitoring techniques in appropriate clinical situations.
Monitoring in ICU
Blood pressure monitoring
NIBP
IBP
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Cardiac output
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Hemodynamics Lecture ARMC
- 8. Four determinants of cardiac output Heart Rate x Stroke Volume Contractility Afterload Preload
- 30. AFTERLOAD Preload PVR CVP SV/CO
- 33. False readings Problem and possible cause What to do False-high reading Cuff too small Make sure cuff bladder is long enough Cuff wrapped too loosely, reducing effective width Tighten cuff Slow cuff deflation, causing venous congestion in arm or leg Never deflate the cuff slower than 2 mmHg/heartbeat Poorly timed measurement (after pt’s eaten, ambulated, appeared anxious, or flexed arm muscles) Postpone BP measurement, or help pt relax before measurement Multiple attempts at reading BP in same arm, causing venous congestion Don’t attempt to measure BP more than twice in same arm; wait several min. btwn attempts False-low reading Incorrect position of arm or leg Make sure arm or leg is level with pt’s heart Failure to notice ausculatory gap sound fades out for 10-15 mmHg, then returns Estimate systolic pressure using palpatation before actually measuring it. Then check the palpable pressure against measurable pressure. Inaudible or low-volume sounds Before reinflating cuff, instruct pt to raise his arm or leg to decrease venous pressure and amplify low-volume sounds. After inflating cuff, tell pt to lower arm or leg. Then deflate cuff and listen. If you still fail to detect sounds, chart the palpable systolic pressure
- 37. Leveling and Zeroing System
- 44. NEVER INFUSE ANYTHING INTO AN A-LINE !!!!!!!
- 48. Use brown port for CVP monitoring. Arrow triple lumen CVC
- 49. Reading the RA/CVP waveform Measure at end expiration at end of QRS complex Using the “Z” point method
- 51. PA Catheter Inflated for Wedge Pressure
- 57. What the hell are you talking about ?
- 68. Q & A...... Whew....Glad thats over !!!!
Editor's Notes
- Afterload is the pressure the ventricles must OVERCOME in order to pump the blood past the aorta.
- Anacrotic rise is the initital upward slope of the waveform when the ventricle is contracting and forcing open the aortic valve.
- Note the first waveform has a rounded peak, a clear dichrotic notch.. When it flushes, the top of the waveform is FLAT. It’s linear… no pulsations. At the end of the flush test, there are a few SHORT oscillations and then the waveform returns to normal as if nothing ever happened. That is a NORMAL flush test and you did everything right, you can use this as a reliable blood pressure value Underdampened waveform, as in… it’s not dampened enough. The systolic peaks are too sharp, when you do the flush test, the line at the top is NOT flat, it’s still pulsating. That means the pressure readings from the artery are greater than the transducer set. When the flush stops, the osccilations are farther apart, and the waveform doesn’t immediately return back to normal, it’s a distorted waveform. This waveform can falsely elevate the systolic BP by up to 25mmHg. How to fix? – shorten catheter tubing length Overdamped system. There’s no dichrotic notch, there’s a narrow pulse pressure… meaning the systolic and diastolic are closer to each other… I mean look at it, it’s almost a flat line. Flush test is linear but too long, there are no oscillations when it returns to normal.