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Hemodynamics - The future, what now?

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Optimising hemodynamics saves lives.
That’s why we all spend so much time trying to do it!
We measure blood pressure, heart rate and SpO2 on anything that moves...
But there is a big problem with this – We are actually just trying to guess what is really going on from very limited data

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Hemodynamics - The future, what now?

  1. 1. The Future – What Next? Prof. Brendan Smith & A/Prof. Veronica Madigan. School of Biomedical Science, Charles Sturt University, Medical School of Notre Dame, Australia, Department of Anaesthesia and Intensive Care, Bathurst Base Hospital, Bathurst, NSW, Australia.
  2. 2. Conflict of Interest / Financial Considerations NONE!!
  3. 3. Optimising haemodynamics saves lives. That’s why we all spend so much time trying to do it! We measure blood pressure, heart rate and SpO2 on anything that moves... But there is a big problem with this – We are actually just trying to guess what is really going on from very limited data...
  4. 4. But none of this tells us DO2 or VO2
  5. 5. “It is impossible to draw conclusions from incomplete data doctor.”
  6. 6. At the 6th PICC we promised 1)That we would publish the method for rapid bedside measurement of inotropy. 2) That we would build the Smith-Madigan Inotropy Index in to the USCOM for everyone to use. 3) That we would publish the results of the BUSH protocol in septic shock study.
  7. 7. www.learnhemodynamics.com
  8. 8. Real-time measurement of S-M Inotropy Index (“INO”)
  9. 9. Starling Curves and Inotropy Index (SMII) +inotropy Left ventricular end diastolic volume Stroke Volume Index 50 25 SV
  10. 10. The Ultimate Diagnostic Device – The Tricorder
  11. 11. OK, so we’re not at the tricorder stage BUT… Using the USCOM 1A with SMII and the BUSH Protocol for the treatment of septic shock resulted in…
  12. 12. TIME TO HD STABILISATION BUSH Non-BUSH 1.25 hrs 19.9 hrs (1.26) (12.9)
  13. 13. MORBIDITY Heart Failure 6.7% 39% 13.7 Respiratory Failure 20% 42.1% 2.92 Renal Failure 8.9% 73.4% 28.6 Tertiary Transfer 4.4% 25% 7.14 BUSH non - OR BUSH
  14. 14. MORTALITY BUSH Non-BUSH OR 6.7% 38% 13.7 (3/42) (24/63) NNT = 3.2
  15. 15. What next? We have to do something similar in paediatric sepsis!!! We need people to joın us ın a multı-centre RCT...
  16. 16. But it’s too hard to learn the USCOM!
  17. 17. Its haemodynamics Jim, but not as we know it! This USCOM is astonishing, Bones!!
  18. 18. Echocardiography is for a few expert users USCOM is for everybody – Learn it in a week, use it for life!!

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