Introduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Introduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring"

Transcription

1 Introduction Invasive Hemodynamic Monitoring Audis Bethea, Pharm.D. Assistant Professor Therapeutics IV January 21, 2004 Hemodynamic monitoring is necessary to assess and manage shock Information obtained through hemodynamic monitoring: Cardiovascular perfomance (right and left ventricular function) Changes in hemodynamic status and organ perfusion Pharmacologic and nonpharmacologic therapy Prognosis Hemodynamic monitoring supplements clinical judgment Cardiovascular System Determinants of Cardiovascular Function Vascular network of > 60,000 miles Circulating 8 L of blood every day Provides O 2 to over 100 trillion cells Right side unoxygenated blood to the lungs Left side oxygenated blood systemically Vasculature Arteries carry blood away from the heart Veins carry blood to the heart Capillaries responsible for exchange of nutrients and gases Cardiac output (CO) = Heart rate (HR) x Stroke volume (SV) Volume of blood ejected from the left ventricle per unit time (L/min) HR is regulated by the sympathetic nervous system SV is the volume of blood ejected by the ventricles during systole Three factors influencing stroke volume Preload (LVEDV or LVEDP) stretching of the LV muscle fibers after diastole Afterload (SVR) force left ventricle has to overcome to eject blood Contractility (Inotropy) force and velocity of muscular contraction Cardiac index (CI) cardiac output adjusted for body surface area Determinants of Cardiovascular Function Hemodynamic Monitoring Preload Determines the strength of ventricular contraction Stroke volume Dependent upon EDV, pleural pressure, vascular compliance, and vascular resistance Contractility Non-invasive Vital signs HR, BP, and RR Arterial oxygen saturation Transthoracic echocardiography Invasive Eliminates potential for error due to measurement technique Assessment is not inhibited in low-flow states Recommended for all ICU patients with cardiovascular instability In 50% of shock patients non-invasive methods underestimate BP by > 30 mmhg

2 Invasive Hemodynamic Monitoring Pulmonary Artery Catheter Arterial catheter Inserted into radial or brachial artery Used for hemodynamic monitoring MAP driving pressure for peripheral blood flow MAP = [SBP + 2(DBP)] / 3 Central venous catheter Administration of IVF and medications Central Venous Pressure Hemodynamic data Volume status Ventricular function Oxygen delivery / consumption Fluid / medication administration CVP = RAP or RVEDP Assesses fluid status or volume s PA Catheter Hemodynamic Parameters PA Catheter Hemodynamic Parameters Cardiac output (CO) 4-7 L/min, Cardiac index (CI) L/min/m 2 Assessment of cardiac function Thermodilution in temperature of blood after injection of cold H 2 O Cardiac malformations / abnormalities may effect measurements Systemic vascular resistance (SVR) dyne/sec/min -5 Vascular resistance across the entire systemic circulation Mean arterial pressure (MAP) mmhg Driving pressure for peripheral blood flow Central venous pressure (CVP) 1-6 mmhg Used to qualitatively assess fluid status or blood volume changes Pulmonary capillary wedge pressure (6 12 mmhg) Closest approximation of preload Objective method of evaluating left ventricular function Elevated PCWP is often indicative of pulmonary edema Pulmonary artery pressure (20 30 mmhg) Pressure produced by the right ventricle ejecting blood into the pulmonary artery Elevated in patients with acute or chronic parenchymal pulmonary disease, PE, hypoxemia, acidosis, and patients receiving vasoactive drugs pulmonary artery pressure occurs with diminished vascular volume Systemic O2 Transport via PA Catheter Systemic O2 Transport via PA Catheter O 2 delivery (Do 2 ) ml/min m 2 Product of CI and Cao 2 Cao 2 = Hemoglobin (Hgb) X arterial O 2 (Sao 2 ) Do 2 = CI x 13.4 x Hgb x Sao 2 Mixed venous O 2 sat. (Svo 2 ) 70 75% Indicator of tissue perfusion Indicator of the body s O 2 consumption (Vo 2 ) Oxygen consumption (Vo 2 ) ml/min m 2 Estimates the oxygen demand of the body Vo 2 = CI x 13.4 x Hb x (Sao 2 Svo 2 ) Vo 2 is independent of supply except at low rates of Do 2 and in critically ill patients Critically ill have an Vo 2 resulting in O 2 deprivation at normal rates of delivery Oxygen extraction ratio (O 2ER ) 20 30% Calculation assesses the uptake of oxygen through the microcirculation (capillaries) O 2ER = (Vo 2 / Do 2 ) x 100

3 Complications of PA Catheters Patient Case Infection Pulmonary infarction Pulmonary thrombosis Arrhythmias Intracardiac damage Pneumothorax Arterial-venous fistulas Pulmonary artery perforation 62 yo male admitted to the ICU following surgical repair of an abdominal aortic aneurysm. The patient is intubated and receiving 60% O 2. He weights 78 kg and has a BSA of 1.8 m 2. He has a history of HTN, (BP 140/100) for which he takes nadolol and HCTZ. His ABGs are adequate and he is receiving 150 ml/hr of LR solution intravenously. His 2-hour post-op and initial (in parentheses) hemodynamic profiles are as follows: BP 90/50 mmhg (130/78), MAP 63 mmhg (95), pulse 88 bpm (80), CO 4 L/min (5), PCWP 6 mmhg (12), SVR 1800 dyne sec cm -5 (1392), urine output 25 ml/hr (70), temperature 37 o C (37), Hgb 8 g/dl (12). Based on the hemodynamic profile, determine the etiology of this patient s cardiovascular failure. 1. What shock state is this patient experiencing? Patient Case Hemodynamic Drugs Answers tomorrow!! These medications are administered via continuous infusion Infusion rate (ml/min) = desired dose rate (R) = R drug concentration (C) C Therapeutic effects elicit vasoconstriction and increased CO Goal of therapy Optimize MAP and/or CO increasing tissue perfusion and O 2 delivery Adrenoreceptors Vasopressors and Inotropes: Norepinephrine Activates α and β 1 receptors Widespread vasoconstriction contractility and SV Hemodynamic parameters BP, HR PCWP, dose-dependent MAP, SVR, dose-dependent CO, mostly at lower doses 2 30 mcg/min; up to 200 mcg/min > 30 mcg/min risk of AE Severe acidosis effects HTN, ischemia, tachyarrhythmias

4 Vasopressors and Inotropes: Epinephrine Vasopressors and Inotropes: Phenylephrine Activates α1, α2, β1, β2 receptors Low dose: vasodilation and CO High dose: vasoconstriction and CO Low dose: HR, minor BP and SVR High dose: HR, BP, PCWP, MAP, SVR CO throughout the dosing range Low dose mcg/kg/min High dose > 0.05 mcg/kg/min Severe acidosis effects HTN, tissue ischemia, tachyarrhythmias Synthetic, non-catecholamine Selectively activates α1 receptors Systemic vasoconstriction BP, PCWP, MAP, SVR mcg/min Moderate acidosis effects HTN, tissue ischemia, reflex bradycardia Vasopressors and Inotropes: Dopamine Vasopressors and Inotropes: Dopamine Dose-dependent α1, α2, β1, β2, DA activity Low dose: vasodilation Mid-dose: vasodilation, HR, contractility High dose: vasoconstriction, HR, contractility Mid-dose: HR, CO, mild MAP, SVR High dose: BP, HR, CO, PCWP, MAP, SVR Low dose mcg/kg/min Mid-dose 3 10 mcg/kg/min High dose mcg/kg/min Moderate to severe acidosis effects HTN, ischemia, tachyarrhythmias Potential tachyphylaxis Vasopressors and Inotropes: Vasopressin Vasopressors and Inotropes: Vasopressin Antidiuretic hormone (ADH) HR, PCWP, CO BP, MAP, SVR Vasodilation due to acidosis Vasopressin reverses effects of acidosis Physiologic activity Serum osmolality Vascular volume Hormones Alterations in serum Paco2 and Pao mcg/min > 0.04 mcg/min risk of AE Acidosis does not affect activity Stimulates vascular V1 receptors Stimulation of renal V2 receptors HTN, tissue ischemia, hypervolemia

5 Vasopressors and Inotropes: Dobutamine Vasopressors and Inotropes: Milrinone Synthetic catecholamine β1, β2 w/ extremely weak α activity in SV, HR β2 activity overcomes the minimal α activity resulting in vasodilation BP and SVR HR and CO 2 20 mcg/kg/min Severe acidosis may effects HTN, hypokalemia, tachyarrythmias Tachyphylaxis Phosphodiesterase inhibitor intracellular camp intracellular Ca ++ intracellular Ca ++, contractility camp promotes relaxation of smooth muscle tissue BP, PCWP, SVR HR, CO (mcg/kg/min) LD: 50 mcg/kg MD: mcg/kg/min Adjust for renal dysfunction CrCl ml/min CrCl 5 20 ml/min CrCl < 5 ml/min not recommended BP, tachyarrhythmia, rare thrombocytopenia Preparation and Administration All admixtures are placed in 250 ml Vasopressin and milrinone are exceptions Dextrose 5% is preferred diluent Premix bags: Dopamine, dobutamine, and milrinone Central line infusion is preferred

FUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART

FUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART FUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART CINDY BITHER, MSN, ANP, ANP, AACC, CHFN CHIEF NP, ADV HF PROGRAM MEDSTAR WASHINGTON HOSPITAL CENTER CONFLICTS OF INTEREST NONE

More information

Topics to be Covered. Cardiac Measurements. Distribution of Blood Volume. Distribution of Pulmonary Ventilation & Blood Flow

Topics to be Covered. Cardiac Measurements. Distribution of Blood Volume. Distribution of Pulmonary Ventilation & Blood Flow Topics to be Covered MODULE F HEMODYNAMIC MONITORING Cardiac Output Determinants of Stroke Volume Hemodynamic Measurements Pulmonary Artery Catheterization Control of Blood Pressure Heart Failure Cardiac

More information

Vasoactive Medications. Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis

Vasoactive Medications. Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis Vasoactive Medications Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis Objectives List components of physiology involved in blood pressure Review terminology related

More information

Swans and Pressors. Vanderbilt Surgery Summer School Ricky Shinall

Swans and Pressors. Vanderbilt Surgery Summer School Ricky Shinall Swans and Pressors Vanderbilt Surgery Summer School Ricky Shinall Shock, Swans, Pressors in 15 minutes 4 Reasons for Shock 4 Swan numbers to know 7 Pressors =15 things to know 4 Reasons for Shock Not enough

More information

Hemodynamic Support. Eric L. Sarin,, MD Fellow, Surgical Critical Care UCHSC Dept of Surgery

Hemodynamic Support. Eric L. Sarin,, MD Fellow, Surgical Critical Care UCHSC Dept of Surgery Hemodynamic Support Eric L. Sarin,, MD Fellow, Surgical Critical Care UCHSC Dept of Surgery Hemodynamic Support Overview Differential Diagnosis of Shock Interpretation of Invasive Monitoring Use of Inotropes

More information

Hemodynamics in the Cath lab and ICU. Arnold Seto, MD, MPA UC-Irvine and Long Beach VA

Hemodynamics in the Cath lab and ICU. Arnold Seto, MD, MPA UC-Irvine and Long Beach VA Hemodynamics in the Cath lab and ICU Arnold Seto, MD, MPA UC-Irvine and Long Beach VA Before you start Is a right heart catheterization planned? What kind of catheter is requested? Will it stay in?

More information

DIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE

DIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE DIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE Mefri Yanni, MD Bagian Kardiologi dan Kedokteran Vaskular RS.DR.M.Djamil Padang The 3rd Symcard Padang, Mei 2013 Outline Diagnosis Diagnosis Treatment options

More information

Titrating Critical Care Medications

Titrating Critical Care Medications Titrating Critical Care Medications Chad Johnson, MSN (NED), RN, CNCC(C), CNS-cc Clinical Nurse Specialist: Critical Care and Neurosurgical Services E-mail: johnsoc@tbh.net Copyright 2017 1 Learning Objectives

More information

Hemodynamic Monitoring and Circulatory Assist Devices

Hemodynamic Monitoring and Circulatory Assist Devices Hemodynamic Monitoring and Circulatory Assist Devices Speaker: Jana Ogden Learning Unit 2: Hemodynamic Monitoring and Circulatory Assist Devices Hemodynamic monitoring refers to the measurement of pressure,

More information

Nothing to Disclose. Severe Pulmonary Hypertension

Nothing to Disclose. Severe Pulmonary Hypertension Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis

More information

Useful diagnostic measures: chest x ray to check pulmonary edema, ECG and ECHO to detect cardiac abnormalities (1).

Useful diagnostic measures: chest x ray to check pulmonary edema, ECG and ECHO to detect cardiac abnormalities (1). Cardiogenic shock Etiology The most common cause of cardiogenic shock is LV dysfunction and necrosis as a result of acute myocardial infarction (AMI) (1). Acute valvular insufficiency or stenosis prevents

More information

Relax and Learn At the Farm 2012

Relax and Learn At the Farm 2012 Relax and Learn At the Farm Session 9: Invasive Hemodynamic Assessment and What to Do with the Data Carol Jacobson RN, MN Cardiovascular Nursing Education Associates Function of CV system is to deliver

More information

Chapter 14 Blood Vessels, Blood Flow and Pressure Exam Study Questions

Chapter 14 Blood Vessels, Blood Flow and Pressure Exam Study Questions Chapter 14 Blood Vessels, Blood Flow and Pressure Exam Study Questions 14.1 Physical Law Governing Blood Flow and Blood Pressure 1. How do you calculate flow rate? 2. What is the driving force of blood

More information

Impedance Cardiography (ICG) Method, Technology and Validity

Impedance Cardiography (ICG) Method, Technology and Validity Method, Technology and Validity Hemodynamic Basics Cardiovascular System Cardiac Output (CO) Mean arterial pressure (MAP) Variable resistance (SVR) Aortic valve Left ventricle Elastic arteries / Aorta

More information

3/10/2009 VESSELS PHYSIOLOGY D.HAMMOUDI.MD. Palpated Pulse. Figure 19.11

3/10/2009 VESSELS PHYSIOLOGY D.HAMMOUDI.MD. Palpated Pulse. Figure 19.11 VESSELS PHYSIOLOGY D.HAMMOUDI.MD Palpated Pulse Figure 19.11 1 shows the common sites where the pulse is felt. 1. Temporal artery at the temple above and to the outer side of the eye 2. External maxillary

More information

Goal-directed vs Flow-guidedresponsive

Goal-directed vs Flow-guidedresponsive Goal-directed vs Flow-guidedresponsive therapy S Magder Department of Critical Care, McGill University Health Centre Flow-directed vs goal directed strategy for management of hemodynamics S Magder Curr

More information

HOW LOW CAN YOU GO? HYPOTENSION AND THE ANESTHETIZED PATIENT.

HOW LOW CAN YOU GO? HYPOTENSION AND THE ANESTHETIZED PATIENT. HOW LOW CAN YOU GO? HYPOTENSION AND THE ANESTHETIZED PATIENT. Donna M. Sisak, CVT, LVT, VTS (Anesthesia/Analgesia) Seattle Veterinary Specialists Kirkland, WA dsisak@svsvet.com THE ANESTHETIZED PATIENT

More information

Pediatric Septic Shock. Geoffrey M. Fleming M.D. Division of Pediatric Critical Care Vanderbilt University School of Medicine Nashville, Tennessee

Pediatric Septic Shock. Geoffrey M. Fleming M.D. Division of Pediatric Critical Care Vanderbilt University School of Medicine Nashville, Tennessee Pediatric Septic Shock Geoffrey M. Fleming M.D. Division of Pediatric Critical Care Vanderbilt University School of Medicine Nashville, Tennessee Case 4 year old male with a history of gastroschesis repaired

More information

7/4/2015. Titrating Vasoactive Drips

7/4/2015. Titrating Vasoactive Drips Leanna R. Miller RN, MN, CCRN-CMC, PCCN-CSC, CEN, NP LRM Consulting Vasoactive medications are indicated when the SBP has a decrease of > 30mmHg from the baseline or a MAP < 60mmHg and when either condition

More information

Nurse Driven Fluid Optimization Using Dynamic Assessments

Nurse Driven Fluid Optimization Using Dynamic Assessments Nurse Driven Fluid Optimization Using Dynamic Assessments 2016 1 WHAT WE BELIEVE We believe that clinicians make vital fluid and drug decisions every day with limited and inconclusive information Cheetah

More information

Pharmacology of inotropes and vasopressors

Pharmacology of inotropes and vasopressors Pharmacology of inotropes and vasopressors Curriculum 3.3 Recognises and manages the patient with circulatory failure 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation PR_BK_41

More information

Cardiac Output (C.O.) Regulation of Cardiac Output

Cardiac Output (C.O.) Regulation of Cardiac Output Cardiac Output (C.O.) Is the volume of the blood pumped by each ventricle per minute (5 Litre) Stroke volume: Is the volume of the blood pumped by each ventricle per beat. Stroke volume = End diastolic

More information

Chapter 9, Part 2. Cardiocirculatory Adjustments to Exercise

Chapter 9, Part 2. Cardiocirculatory Adjustments to Exercise Chapter 9, Part 2 Cardiocirculatory Adjustments to Exercise Electrical Activity of the Heart Contraction of the heart depends on electrical stimulation of the myocardium Impulse is initiated in the right

More information

Surviving Sepsis Campaign Guidelines 2012 & Update for David E. Tannehill, DO Critical Care Medicine Mercy Hospital St.

Surviving Sepsis Campaign Guidelines 2012 & Update for David E. Tannehill, DO Critical Care Medicine Mercy Hospital St. Surviving Sepsis Campaign Guidelines 2012 & Update for 2015 David E. Tannehill, DO Critical Care Medicine Mercy Hospital St. Louis Be appropriately aggressive the longer one delays aggressive metabolic

More information

Rounds in the ICU. Eran Segal, MD Director General ICU Sheba Medical Center

Rounds in the ICU. Eran Segal, MD Director General ICU Sheba Medical Center Rounds in the ICU Eran Segal, MD Director General ICU Sheba Medical Center Real Clinical cases (including our mistakes) Emphasis on hemodynamic monitoring Usually no single correct answer We will conduct

More information

Hemodynamic Monitoring

Hemodynamic Monitoring Perform Procedure And Interpret Results Hemodynamic Monitoring Tracheal Tube Cuff Pressure Dean R. Hess PhD RRT FAARC Hemodynamic Monitoring Cardiac Rate and Rhythm Arterial Blood Pressure Central Venous

More information

Cardiovascular Physiology. Heart Physiology. Introduction. The heart. Electrophysiology of the heart

Cardiovascular Physiology. Heart Physiology. Introduction. The heart. Electrophysiology of the heart Cardiovascular Physiology Heart Physiology Introduction The cardiovascular system consists of the heart and two vascular systems, the systemic and pulmonary circulations. The heart pumps blood through

More information

เอกราช อร ยะช ยพาณ ชย

เอกราช อร ยะช ยพาณ ชย 25 September 2017 เอกราช อร ยะช ยพาณ ชย Heart Failure and Transplant Cardiology aekarach.a@chula.ac.th Presentation at 1 Agenda Physiology of the heart Pathophysiology of shock Pathophysiology of heart

More information

9/13/2015. Laboratory. HPI and PE

9/13/2015. Laboratory. HPI and PE Critical Care HPI and PE 74 yo male confused SBP 90/20 MAP50, P 122, RR 34 Ox1 w/o nuchal rigidity S1S2 wo m RLL reduced breath sounds Skin warm dry Laboratory» WBC 15,600 Hgb 8.4 HCt 23%, Plts 95000,

More information

Cardiac Output Monitoring - 6

Cardiac Output Monitoring - 6 Cardiac Output Monitoring - 6 How to use Wrexham s Cardiac Output Monitors. Wrexham Maelor Critical Care Version 02.05.16 Introduction Types of Devices: NICOM - Cheetah Oesophageal Doppler +/- Pulse Contour

More information

Effects of mechanical ventilation on organ function. Masterclass ICU nurses

Effects of mechanical ventilation on organ function. Masterclass ICU nurses Effects of mechanical ventilation on organ function Masterclass ICU nurses Case Male, 60 - No PMH - L 1.74 m and W 85 kg Pneumococcal pneumonia Stable hemodynamics - No AKI MV in prone position (PEEP 16

More information

Principles of Biomedical Systems & Devices. Lecture 8: Cardiovascular Dynamics Dr. Maria Tahamont

Principles of Biomedical Systems & Devices. Lecture 8: Cardiovascular Dynamics Dr. Maria Tahamont Principles of Biomedical Systems & Devices Lecture 8: Cardiovascular Dynamics Dr. Maria Tahamont Review of Cardiac Anatomy Four chambers Two atria-receive blood from the vena cave and pulmonary veins Two

More information

DO 2 > VO 2. The amount of oxygen delivered is a product of cardiac output (L/min) and the amount of oxygen in the arterial blood (ml/dl).

DO 2 > VO 2. The amount of oxygen delivered is a product of cardiac output (L/min) and the amount of oxygen in the arterial blood (ml/dl). Shock (Part 1): Review and Diagnostic Approach Jeffrey M. Todd, DVM, DACVECC University of Minnesota, St. Paul, MN Overview Shock is the clinical presentation of inadequate oxygen utilization, typically

More information

Circulation. Blood Pressure and Antihypertensive Medications. Venous Return. Arterial flow. Regulation of Cardiac Output.

Circulation. Blood Pressure and Antihypertensive Medications. Venous Return. Arterial flow. Regulation of Cardiac Output. Circulation Blood Pressure and Antihypertensive Medications Two systems Pulmonary (low pressure) Systemic (high pressure) Aorta 120 mmhg Large arteries 110 mmhg Arterioles 40 mmhg Arteriolar capillaries

More information

Resuscitation Before Emergency Surgeries FEIRAN LOU SUNY DOWNSTATE MEDICAL CENTER KINGS COUNTY HOSPITAL

Resuscitation Before Emergency Surgeries FEIRAN LOU SUNY DOWNSTATE MEDICAL CENTER KINGS COUNTY HOSPITAL Resuscitation Before Emergency Surgeries FEIRAN LOU SUNY DOWNSTATE MEDICAL CENTER KINGS COUNTY HOSPITAL Case 73 yo woman h/o HTN three days abdominal pain and nausea. The pain was diffuse, cramp-like,

More information

The Use of Dynamic Parameters in Perioperative Fluid Management

The Use of Dynamic Parameters in Perioperative Fluid Management The Use of Dynamic Parameters in Perioperative Fluid Management Gerard R. Manecke Jr., M.D. Chief, Cardiac Anesthesia UCSD Medical Center San Diego, CA, USA Thanks to Tom Higgins, M.D. 1 Goals of today

More information

Pre-operative usage of IABP for patients for by pass surgery

Pre-operative usage of IABP for patients for by pass surgery Pre-operative usage of IABP for patients for by pass surgery Mitrev Z, Anguseva T, Hristov N Special hospital for surgery Filip Vtori Skopje - Macedonija Oktomvri, 2008 IABP Background Preload Afterload

More information

TOPIC : Cardiogenic Shock

TOPIC : Cardiogenic Shock University of Ferrara Department of Morphology, Surgery and Experimental Medicine. Section of Anaesthesia and Intensive Care Medicine TOPIC : Cardiogenic Shock What is shock? Shock is a condition of inadequate

More information

Heart Failure (HF) Treatment

Heart Failure (HF) Treatment Heart Failure (HF) Treatment Heart Failure (HF) Complex, progressive disorder. The heart is unable to pump sufficient blood to meet the needs of the body. Its cardinal symptoms are dyspnea, fatigue, and

More information

Sepsis is a complicated infectious process that propagates. Use of Vasopressors in Septic Shock. Clinical review

Sepsis is a complicated infectious process that propagates. Use of Vasopressors in Septic Shock. Clinical review Use of Vasopressors in Septic Shock Megan A. Rech, PharmD, Megan Prasse, PharmD, and Gourang Patel, PharmD, MSc Abstract Objective: To review the latest findings on the use of vasopressor agents in septic

More information

Objectives. Epidemiology of Sepsis. Review Guidelines for Resuscitation. Tx: EGDT, timing/choice of abx, activated

Objectives. Epidemiology of Sepsis. Review Guidelines for Resuscitation. Tx: EGDT, timing/choice of abx, activated Update on Surviving Sepsis 2008 Objectives Epidemiology of Sepsis Definition of Sepsis and Septic Shock Review Guidelines for Resuscitation Dx: Lactate, t cultures, SVO2 Tx: EGDT, timing/choice of abx,

More information

Medical Management of Acutely Decompensated Heart Failure. William T. Abraham, MD Director, Division of Cardiovascular Medicine

Medical Management of Acutely Decompensated Heart Failure. William T. Abraham, MD Director, Division of Cardiovascular Medicine Medical Management of Acutely Decompensated Heart Failure William T. Abraham, MD Director, Division of Cardiovascular Medicine Orlando, Florida October 7-9, 2011 Goals of Acute Heart Failure Therapy Alleviate

More information

The Treatment Targets in Acute Decompensated Heart Failure

The Treatment Targets in Acute Decompensated Heart Failure SUCCESS WITH HEART FAILURE The Treatment Targets in Acute Decompensated Heart Failure Gregg C. Fonarow, MD The Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, UCLA School of Medicine, Los

More information

Cardiac Output (CO) Definitions. Cardiac Output and venous return. Dr Badri Paudel GMC. Cardiac Output. Venous Return

Cardiac Output (CO) Definitions. Cardiac Output and venous return. Dr Badri Paudel GMC. Cardiac Output. Venous Return Cardiac Output and venous return Dr Badri Paudel GMC Definitions Cardiac Output The quantity of blood pumped into the aorta each minute measured in milliliters (ml) per minute (min) or liters (L) per minute

More information

Revision of 10/27/2017 Form #280 Page 1 of 12 PVDOMICS STUDY Clinical Center Right Heart Catheterization (RHC) Results Form #280

Revision of 10/27/2017 Form #280 Page 1 of 12 PVDOMICS STUDY Clinical Center Right Heart Catheterization (RHC) Results Form #280 Revision of 10/27/2017 Form #280 Page 1 of 12 PVDOMICS STUDY Clinical Center Right Heart Catheterization (RHC) Results Form #280 Instructions: Review PVDOMICS MOP Chapter 100 prior to completing right

More information

Intravenous Inotropic Support an Overview

Intravenous Inotropic Support an Overview Intravenous Inotropic Support an Overview Shaul Atar, MD Western Galilee Medical Center, Nahariya Affiliated with the Faculty of Medicine of the Galilee, Safed, Israel INOTROPES in Acute HF (not vasopressors)

More information

Blood Pressure Regulation. Faisal I. Mohammed, MD,PhD

Blood Pressure Regulation. Faisal I. Mohammed, MD,PhD Blood Pressure Regulation Faisal I. Mohammed, MD,PhD 1 Objectives Outline the short term and long term regulators of BP Know how baroreceptors and chemoreceptors work Know function of the atrial reflex.

More information

Dr Nick Taylor Visiting Emergency Specialist Teaching Hospital Karapitiya

Dr Nick Taylor Visiting Emergency Specialist Teaching Hospital Karapitiya Dr Nick Taylor Visiting Emergency Specialist Teaching Hospital Karapitiya Senior Specialist and Director ED Training Clinical Lecturer, Australian National University Canberra Hospital, Australia Inotropes

More information

FloTrac Sensor and Edwards PreSep Central Venous Oximetry Catheter Case Presentations

FloTrac Sensor and Edwards PreSep Central Venous Oximetry Catheter Case Presentations Edwards FloTrac Sensor & Edwards Vigileo Monitor FloTrac Sensor and Edwards PreSep Central Venous Oximetry Catheter Case Presentations 1 Topics System Configuration FloTrac Sensor and PreSep Catheter Thoracotomy

More information

The Anatomy and Physiology of the Circulatory System

The Anatomy and Physiology of the Circulatory System CHAPTER 5 The Anatomy and Physiology of the Circulatory System The Circulatory System Blood Heart Vascular System THE BLOOD Formed Elements of Blood Table 5-1 Cell Type Erythrocytes (Red Blood Cells, RBCs)

More information

Cardiovascular Physiology and Pharmacology

Cardiovascular Physiology and Pharmacology Cardiovascular Physiology and Pharmacology Peter Paal Perioperative Medicine, Barts Heart Centre St. Bartholomew s Hospital, Barts Healt NHS Queen Mary University of London and Department of Anaesthesiology

More information

Mechanical ventilation induced or exacerbated right ventricular failure

Mechanical ventilation induced or exacerbated right ventricular failure Mechanical ventilation induced or exacerbated right ventricular failure Toronto 2016 Jesse Hall MD Professor of Medicine, Anesthesia & Critical Care University of Chicago Faculty Disclosures Dr. Hall

More information

Sepsis in 15 Minutes. Frank Stegall PGY3. Adapted from prior lectures by Dr. Romain, et al.

Sepsis in 15 Minutes. Frank Stegall PGY3. Adapted from prior lectures by Dr. Romain, et al. Sepsis in 15 Minutes Frank Stegall PGY3 Adapted from prior lectures by Dr. Romain, et al. What is Clinical Sepsis? A medical condition that is characterized by a whole body inflammatory state and the presence

More information

Chapter 21. Flail Chest. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 21. Flail Chest. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 21 Flail Chest 1 Figure 21-1. Flail chest. Double fractures of three or more adjacent ribs produce instability of the chest wall and paradoxical motion of the thorax. Inset, Atelectasis, a common

More information

Cardiovascular Physiology

Cardiovascular Physiology Cardiovascular Physiology Introduction The cardiovascular system consists of the heart and two vascular systems, the systemic and pulmonary circulations. The heart pumps blood through two vascular systems

More information

Shock Management. Seyed Tayeb Moradian MSc, Critical Care Nursing Ph.D Candidate. PDF created with pdffactory Pro trial version

Shock Management. Seyed Tayeb Moradian MSc, Critical Care Nursing Ph.D Candidate. PDF created with pdffactory Pro trial version Shock Management Seyed Tayeb Moradian MSc, Critical Care Nursing Ph.D Candidate Definition of Shock The definition of shock does not involve low blood pressure, rapid pulse or cool clammy skin - these

More information

Objectives. Management of Septic Shock. Definitions Progression of sepsis. Epidemiology of severe sepsis. Major goals of therapy

Objectives. Management of Septic Shock. Definitions Progression of sepsis. Epidemiology of severe sepsis. Major goals of therapy Objectives Management of Septic Shock Review of the Evidence and Implementation of Pediatric Guidelines at Christus Santa Rosa Manish Desai, M.D. PL 5 2 nd year Pediatric Critical Care Fellow Review of

More information

SHOCK. May 12, 2011 Body and Disease

SHOCK. May 12, 2011 Body and Disease SHOCK May 12, 2011 Body and Disease Shock Definition of shock Pathophysiology Types of shock Management of shock Shock Definition? Shock What the Duke Community would have experienced if Gordon Hayward

More information

Definition- study of blood flow Haemodynamic monitoring refers to monitoring of blood in the cardiovascular system Uses Is NB in the critically ill

Definition- study of blood flow Haemodynamic monitoring refers to monitoring of blood in the cardiovascular system Uses Is NB in the critically ill By Craig Definition- study of blood flow Haemodynamic monitoring refers to monitoring of blood in the cardiovascular system Uses Is NB in the critically ill pt Can assist diagnosis and decision making

More information

IP: Regulation of Cardiac Output

IP: Regulation of Cardiac Output ANP 1105D Winter 2013 Assignment 9: The Heart, part 2: Chap... Assignment 9: The Heart, part 2: Chapter 18 Signed in as Alex Sokolowski Help Close Resources Due: 11:59pm on Monday, March 25, 2013 Note:

More information

Diagnosis & Management of Heart Failure. Abena A. Osei-Wusu, M.D. Medical Fiesta

Diagnosis & Management of Heart Failure. Abena A. Osei-Wusu, M.D. Medical Fiesta Diagnosis & Management of Heart Failure Abena A. Osei-Wusu, M.D. Medical Fiesta Learning Objectives: 1) Become familiar with pathogenesis of congestive heart failure. 2) Discuss clinical manifestations

More information

Mechanical circulatory support in cardiogenic shock The Cardiologist s view ACCA Masterclass 2017

Mechanical circulatory support in cardiogenic shock The Cardiologist s view ACCA Masterclass 2017 Mechanical circulatory support in cardiogenic shock The Cardiologist s view ACCA Masterclass 2017 Pascal Vranckx MD, PhD. Medical director Cardiac Critical Care Services Hartcentrum Hasselt Belgium Disclosure

More information

SEPSIS RAPID RESPONSE

SEPSIS RAPID RESPONSE SEPSIS RAPID RESPONSE Sepsis kills up to 50% of those infected. How many deaths will you prevent this year? 1 SEPSIS Back ground: According to the Institute for Health Improvement and the Surviving Sepsis

More information

The Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the PreSep oximetry catheter for

The Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the PreSep oximetry catheter for 1 2 The Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the PreSep oximetry catheter for continuous central venous oximetry (ScvO2) 3 The Vigileo

More information

Shock. Shao Mian Emergency Department,Zhongshan Hospital

Shock. Shao Mian Emergency Department,Zhongshan Hospital Shock Shao Mian Emergency Department,Zhongshan Hospital What is shock THE BEGINNINGS OF UNDERSTANDING: THE LATE 19TH CENTURY THE AGE OF REASON: 1890 1925 THE MODERN ERA: BLALOCK S EPIPHANY POSTMODERNISM:

More information

UPMC Critical Care

UPMC Critical Care UPMC Critical Care www.ccm.pitt.edu Shock and Monitoring Samuel A. Tisherman, MD, FACS, FCCM Professor Departments of CCM and Surgery University of Pittsburgh Shock Anaerobic metabolism Lactic acidosis

More information

Performance Enhancement. Cardiovascular/Respiratory Systems and Athletic Performance

Performance Enhancement. Cardiovascular/Respiratory Systems and Athletic Performance Performance Enhancement Cardiovascular/Respiratory Systems and Athletic Performance Functions of the Cardiovascular System Deliver oxygen & nutrients to body tissues Carry wastes from the cells Anatomy

More information

Wet Lungs Dry lungs Impact on Outcome in ARDS. Charlie Phillips MD Division of PCCM OHSU 2009

Wet Lungs Dry lungs Impact on Outcome in ARDS. Charlie Phillips MD Division of PCCM OHSU 2009 Wet Lungs Dry lungs Impact on Outcome in ARDS Charlie Phillips MD Division of PCCM OHSU 2009 Today s talk Pathophysiology of ARDS The case for dry Targeting EVLW Disclosures Advisor for Pulsion Medical

More information

The Hemodynamics of PH Interpreting the numbers

The Hemodynamics of PH Interpreting the numbers The Hemodynamics of PH Interpreting the numbers Todd M Bull MD Associate Professor of Medicine Division of Pulmonary Sciences and Critical Care Medicine Pulmonary Hypertension Center University of Colorado

More information

R2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital

R2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference

More information

Endpoints of Resuscitation for Circulatory Shock: When Enough is Enough?

Endpoints of Resuscitation for Circulatory Shock: When Enough is Enough? Endpoints of Resuscitation for Circulatory Shock: When Enough is Enough? Emanuel P. Rivers, MD, MPH, IOM Vice Chairman and Research Director Departments of Emergency Medicine and Surgery Henry Ford Hospital

More information

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Cardiac Anatomy

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Cardiac Anatomy Mosby,, an affiliate of Elsevier Normal Cardiac Anatomy Impaired cardiac pumping Results in vasoconstriction & fluid retention Characterized by ventricular dysfunction, reduced exercise tolerance, diminished

More information

Δακτυλίτιδα και Ινότροπα Φάρμακα στην Καρδιακή Ανεπάρκεια. Ι.Κανονίδης

Δακτυλίτιδα και Ινότροπα Φάρμακα στην Καρδιακή Ανεπάρκεια. Ι.Κανονίδης Δακτυλίτιδα και Ινότροπα Φάρμακα στην Καρδιακή Ανεπάρκεια Ι.Κανονίδης Cardiac Glycosides Chronic Congestive Heart Failure DIGOXIN Na-K ATPase Na + K + Na-Ca Exchange Na + Ca ++ Ca ++ K + Na + Myofilaments

More information

FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL

FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL COLLEGE NOVEMBER 10 TH 2017 TEXAS SCCM SYMPOSIUM Disclosures

More information

How to apply advanced hemodynamic parameters in the ICU 奇美醫學中心

How to apply advanced hemodynamic parameters in the ICU 奇美醫學中心 How to apply advanced hemodynamic parameters in the ICU 奇美醫學中心 加護醫學部 楊俊杰醫師 Outlines Case presentation PiCCOmonitor Edwards EV 1000 Case presentation Day 1-At ED (1) 72 y/o male C.C: shortness of breath,

More information

IN THE NAME OF GOD SHOCK MANAGMENT OMID MORADI MOGHADDAM,MD,FCCM IUMS ASSISTANT PROFESSOR

IN THE NAME OF GOD SHOCK MANAGMENT OMID MORADI MOGHADDAM,MD,FCCM IUMS ASSISTANT PROFESSOR IN THE NAME OF GOD SHOCK MANAGMENT OMID MORADI MOGHADDAM,MD,FCCM IUMS ASSISTANT PROFESSOR The ability to evaluate and manage a critically ill patient is one of the most important skills any intensivist

More information

Age-related changes in cardiovascular system. Dr. Rehab Gwada

Age-related changes in cardiovascular system. Dr. Rehab Gwada Age-related changes in cardiovascular system Dr. Rehab Gwada Objectives explain the main structural and functional changes in cardiovascular system associated with normal aging Introduction aging results

More information

1. Distinguish among the types of blood vessels on the basis of their structure and function.

1. Distinguish among the types of blood vessels on the basis of their structure and function. Blood Vessels and Circulation Objectives This chapter describes the structure and functions of the blood vessels Additional subjects contained in Chapter 13 include cardiovascular physiology, regulation,

More information

Cardiovascular Responses to Exercise

Cardiovascular Responses to Exercise CARDIOVASCULAR PHYSIOLOGY 69 Case 13 Cardiovascular Responses to Exercise Cassandra Farias is a 34-year-old dietician at an academic medical center. She believes in the importance of a healthy lifestyle

More information

Meet the experts: Cardiogenic Shock

Meet the experts: Cardiogenic Shock Meet the experts: Cardiogenic Shock Inotropes: effects on the heart, the microcirculation and other organs ACCA Masterclass 2017 Alessandro Sionis Director Acute & Intensive Cardiac Care Unit Hospital

More information

ECLS Registry Form Extracorporeal Life Support Organization (ELSO)

ECLS Registry Form Extracorporeal Life Support Organization (ELSO) ECLS Registry Form Extracorporeal Life Support Organization (ELSO) Center ID: Center name: Run No (for this patient) Unique ID: Birth Date/Time Sex: (M, F) Race: (Asian, Black, Hispanic, White, Other)

More information

AATS/Cardiothoracic Critical Care Symposium

AATS/Cardiothoracic Critical Care Symposium AATS/Cardiothoracic Critical Care Symposium Balancing Pharmacologic and Mechanical Support Robert L Kormos MD, FACS, FRCS(C), FAHA I have no disclosures and will not discuss off label use of drugs or devices

More information

Assist Devices in STEMI- Intra-aortic Balloon Pump

Assist Devices in STEMI- Intra-aortic Balloon Pump Assist Devices in STEMI- Intra-aortic Balloon Pump Ioannis Iakovou, MD, PhD Onassis Cardiac Surgery Center Athens, Greece Cardiogenic shock 5-10% of pts after a heart attack 60000-70000 pts in Europe/year

More information

6/5/2014. Sepsis Management and Hemodynamics. 2004: International group of experts,

6/5/2014. Sepsis Management and Hemodynamics. 2004: International group of experts, Sepsis Management and Hemodynamics Javier Perez-Fernandez, M.D., F.C.C.P. Medical Director Critical Care Services, Baptist t Hospital of Miamii Medical Director Pulmonary Services, West Kendall Baptist

More information

-Cardiogenic: shock state resulting from impairment or failure of myocardium

-Cardiogenic: shock state resulting from impairment or failure of myocardium Shock chapter Shock -Condition in which tissue perfusion is inadequate to deliver oxygen, nutrients to support vital organs, cellular function -Affects all body systems -Classic signs of early shock: Tachycardia,tachypnea,restlessness,anxiety,

More information

Critical Thinking Tip Sheets

Critical Thinking Tip Sheets 12 Lead EKG Review Critical Thinking Tip Sheets Area of myocardium Coronary artery involved Leads affected INFERIOR RCA II, III, AVF SEPTAL LAD V1 & V2 ANTERIOR LAD V3 & V4 LATERAL Circumflex I, AVL, V5,

More information

VASOACTIVE DRUGS AND THEIR USE IN SHOCK. Learning Objectives. Shock 10/5/2016

VASOACTIVE DRUGS AND THEIR USE IN SHOCK. Learning Objectives. Shock 10/5/2016 VASOACTIVE DRUGS AND THEIR USE IN SHOCK October 13, 2016 David Castillo, PharmD, BCPS Emergency Department Lead Clinical Pharmacist Peacehealth Southwest Medical Center DCastillo@peacehealth.org Learning

More information

CrackCast Episode 6 Shock

CrackCast Episode 6 Shock CrackCast Episode 6 Shock Episode overview: 1) List, define and explain the 5 causes of shock 2) What is the utility of lactate and base deficit in the management of shock? 3) Define: SIRS, Sepsis, Severe

More information

SHOCK and the Trauma Victim. JP Pretorius Department of Surgery & SICU Steve Biko Academic Hospital.

SHOCK and the Trauma Victim. JP Pretorius Department of Surgery & SICU Steve Biko Academic Hospital. SHOCK and the Trauma Victim JP Pretorius Department of Surgery & SICU Steve Biko Academic Hospital. Classification of Shock Cardiogenic - Myopathic Arrythmic Mechanical Hypovolaemic - Haemorrhagic Non-haemorrhagic

More information

The Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the Edwards PreSep oximetry catheter

The Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the Edwards PreSep oximetry catheter 1 2 The Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the Edwards PreSep oximetry catheter for continuous central venous oximetry (ScvO2) 3

More information

BASIC CRITICAL CARE OF THE PATIENT. Hannelisa Callisen PA C February 2017

BASIC CRITICAL CARE OF THE PATIENT. Hannelisa Callisen PA C February 2017 BASIC CRITICAL CARE OF THE PATIENT Hannelisa Callisen PA C February 2017 Disclosures Industry: None ECMO is off label Objectives ECMO initiation selection, cannulation Physiology : Review of DO2 on ECMO

More information

NE refractoriness: From Definition To Treatment... Prof. Alain Combes

NE refractoriness: From Definition To Treatment... Prof. Alain Combes NE refractoriness: From Definition To Treatment... Prof. Alain Combes Service de Réanimation ican, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris Université Pierre

More information

Commrison of DoDamine and Dobutamine TheGpy during Inkaaortic Balloon Pumping for the Treatment of Postcardiotomy Low-Output Syndrome

Commrison of DoDamine and Dobutamine TheGpy during Inkaaortic Balloon Pumping for the Treatment of Postcardiotomy Low-Output Syndrome Commrison of DoDamine and Dobutamine TheGpy during Inkaaortic Balloon Pumping for the Treatment of Postcardiotomy LowOutput Syndrome Rosalyn P. Sterling, M.D., Heinrich Taegtmeyer, M.D., Stephen A. Turner,

More information