Making the Case For Less Invasive Flow Based Parameters: APCO + SVV. Patricia A. Meehan, RN, MS, CCRN (a) Education Consultant Edwards Lifesciences
|
|
- Wilfred Hardy
- 5 years ago
- Views:
Transcription
1 Making the Case For Less Invasive Flow Based Parameters: APCO + SVV Patricia A. Meehan, RN, MS, CCRN (a) Education Consultant Edwards Lifesciences
2 A New Gold Standard?
3 How does the system work? Sensor measures the pressure variation from the existing arterial line. Pulse pressure proportional to SV. Monitor uses Sensor values to continuously compute SV. Input age, gender, ht, and wt to determine patient-specific vascular compliance. Dynamic changes in the peripheral resistance and vascular tone, which affect pulse pressure, are compensated for. Monitor displays CO on a continuous basis (every 20 sec) by multiplying the pulse rate and computed SV.
4 Technology Description SBP PP SV SD SV DBP PP (SBP DBP) is proportional to SV. (Inversely proportional to aortic compliance) Full arterial pulse waveform is assessed at 100 Hz. Variability (SD) of the arterial pressure is made over a 20 second window. SD is proportional to SV. SV x PR = CO
5 What about vascular changes? Effect of altered vessel compliance and changing resistance: Software compensates for physiologic effects on arterial pressure: Effect of large vessel compliance Age, gender, height, weight Effect of peripheral resistance Assessment of waveform elements associated with vascular changes
6 Effect of peripheral resistance The algorithm looks for characteristic changes in arterial pressure that affect flow Those changes are included in the calculation of SV Quick rise in pressure - Increased resistance Increase MAP - Increased resistance Dramatic increase/decrease in pressure within same time altered resistance
7
8 Concerns and Potential Limitations 1. Factors affecting arterial pressure monitoring Prime tubing - Components Proper leveling Proper zeroing Square Wave Test 2. Causes of irregular heart rate 3. Concerns with additional calibration
9 A clinical question: Can the head of bed be raised? Angles YES, BUT... must ensure that the transducer air fluid interface is raised as well!
10 Pressure Tracing Showing Erroneous Values due to Bed Height Movements Bed Raised Bed Raised Bed Raised Bed Lowered Bed Lowered
11 Arterial Pressure Based Technologies that use the arterial pressure to determine cardiac output can be affected by the quality of the arterial pressure tracing. Note the impact of an overdamped tracing on the LiDCO cardiac output value. Jansen & van den Berg 2005 Technologies
12 Basic parameters: Are they enough? Mr. B is a 58 y/o male. Post-op AAA monitored in the PACU with noninvasive technology. Is Mr. B stable?
13 Gave Volume 1 Mr. B is given a 500 ml fluid bolus. The MAP increased slightly. HR decreased slightly. Is this sufficient?
14 Gave Volume 2 Mr. B is given another 250 ml bolus of fluid. The MAP increased slightly. HR decreased slightly. Does the blood pressure reflect flow?
15 Does Pressure = Flow? Headley 2006 Critical Care Nurse Clinics of North America
16 Assumptions: Blood pressure reflects flow MAP = CO If BP goes up then CO goes up.. If CO is down then BP is down Assumption P = F is really a MISCONCEPTION
17 What Makes an Arterial Pulse? Arterial SV SBP PP SV Cardiac Output MAP Arterial Tone: Compliance Resistance DBP JMHeadley 2005 Arterial SVR
18 Does Pressure = Flow? Headley 2006 Critical Care Nurse Clinics of North America
19 MAP: slow to respond, does not tell the full story.. It should be recognized that systemic hypo-perfusion usually precedes hypotension, especially in patients with sepsis MAP ~ SVR X CO Rackow, JAMA 1991 P = R x F (Schwaitzberg, J Ped Surg, 1988)
20 Added CVP Mr. B now has a central line placed. CVP is within normal range. Do Nothing? Add Cardiac Output? Did this add more information to the case? Give Volume? Add SVV?
21 Preload Responsiveness: Which test is best? A. Traditional clinical markers of hypovolemia Low Urine Output - limited with AKI and CRF Dry mucous membranes B. CVP and PAWP C. Response of BP to a fluid bolus D. SVV and PPV
22 P V Preload indices such as CVP, RAP, PAOP, and LVEDP are poor predictors of preload status and volume responsiveness. Altered ventricular compliance affects the P/V relationship. These are also known as static indices as they do not predict the patient s response to fluid.
23 Kumar et al. CCM 2004 CVP and PAOP: Poor Predictors of Fluid Status Pressure based indices did not correlate to volume or change in stroke volume after a fluid bolus. Pre-fluid bolus Post fluid bolus Pre-fluid bolus Post fluid bolus
24 Added Cardiac Output The decision was made to add APCO to assess flow. An arterial line was inserted and attached to a FloTrac sensor. Did this add more information to the case?
25 Added Cardiac Output Volume was given CO increased but only by 10% Would additional parameters provide needed information in a more timely manner?
26 Pulsus Paradoxus: The Origin of SVV Pulsus Paradoxus is the origin of SVV value. Occurs with spontaneously breathing patients. Reverse Pulsus Paradoxus Occurs during positive pressure ventilation. Clinical use of this phenomenon remains marginal. Michard Anesthesiology 2005
27 Added SVV The stroke volume variation is abnormally elevated. Normal is 10 15%. This indicates that the patient will be responsive to fluid Did this add more information to the case?
28
29 Kungys, Rose, Fleming 2009 Basic hemodynamic variables such as HR and arterial blood pressure may not have the sensitivity required for optimal care.
30 Kungys, Rose, Fleming 2009 Optimization of intravascular volume based on real-time changes in SVV may be an appropriate strategy, especially for patients in whom tighter control of fluid replacement is beneficial.
31 Right monitor for the Right Patient An improved understanding of these emerging technologies will assist the intensivist in applying the appropriate device to his or her particular setting. Minimally invasive hemodynamic monitoring for the intensivist: Current and emerging technologies Chaney & Derdak Crit Care Med 2002
32 Making the Case For Less Invasive Flow Based Parameters: APCO +SVV CAUTION: Federal (United States) law restricts this device to sale by or on the order of a physician. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions and adverse events. Patricia A. Meehan is a paid consultant of Edwards Lifesciences. Any quotes used in this material are taken from independent third-party publications and are not intended to imply that such third party received or endorsed any of the products of Edwards Lifesciences. As a member of the Advanced Medical Technology Association ("AdvaMed"), Edwards Lifesciences strictly adheres to the requirements of the AdvaMed Code of Ethics regarding interactions with health care professionals. Edwards Lifesciences wishes to disclose that all speakers, instructors and panel members will receive compensation and reimbursement of reasonable travel expenses from Edwards Lifesciences for their services in full compliance with all applicable laws, rules and regulations, including the AdvaMed Code of Ethics. Edwards is a trademark of Edwards Lifesciences Corporation. Edwards Lifesciences, and the stylized E logo, the FloTrac and Vigileo are trademarks of Edwards Lifesciences Corporation and are registered in the United States Patent and Trademark Office Edwards Lifesciences. All rights reserved. AR06143
33
Assessing Preload Responsiveness Using Arterial Pressure Based Technologies. Patricia A. Meehan, RN, MS Education Consultant Edwards Lifesciences, LLC
Assessing Preload Responsiveness Using Arterial Pressure Based Technologies Patricia A. Meehan, RN, MS Education Consultant Edwards Lifesciences, LLC Content Description : Fluid administration is a first
More informationEdwards FloTrac Sensor & Performance Assessments of the FloTrac Sensor and Vigileo Monitor
Edwards FloTrac Sensor & Edwards Vigileo Monitor Performance Assessments of the FloTrac Sensor and Vigileo Monitor 1 Topics System Configuration Performance and Validation Dr. William T. McGee, Validation
More informationThe 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 informationFloTrac 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 informationJan M. Headley, R.N. BS
Fluid First: Using PLR & SVV to Optimize Volume Jan M. Headley, R.N. BS Disclosure Director, Clinical Marketing & Professional Education Edwards Lifesciences Does this Patient NEED Fluid?? WE Have a Problem
More informationThe 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 informationThe 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 informationThe 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 (ScvO 2 ) 3 The Vigileo
More informationHemodynamic Monitoring Pressure or Volumes? Antonio Pesenti University of Milan Italy
Hemodynamic Monitoring Pressure or Volumes? Antonio Pesenti University of Milan Italy antonio.pesenti@unimi.it CCCF 2017 Is it useful? YES: CVP It is an important diagnostic element! Your best guess CVP
More informationFLUIDS AND SOLUTIONS IN THE CRITICALLY ILL. Daniel De Backer Department of Intensive Care Erasme University Hospital Brussels, Belgium
FLUIDS AND SOLUTIONS IN THE CRITICALLY ILL Daniel De Backer Department of Intensive Care Erasme University Hospital Brussels, Belgium Why do we want to administer fluids? To correct hypovolemia? To increase
More informationThe 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 information86% P(iBP) Hypotension. Clarity
86% P(iBP) Hypotension Clarity Hypotension Probability Indicator Know before it s low. The Acumen software Hypotension Probability Indicator is a nextgeneration clinical decision support tool that enables
More informationRelax 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 informationWhat you need. When you need it. EV1000 Clinical Platform
What you need. When you need it. EV1000 Clinical Platform EV1000 Clinical Platform The EV1000 clinical platform from Edwards Lifesciences presents the physiologic status of the patient in an intuitive
More informationSepsis Wave II Webinar Series. Sepsis Reassessment
Sepsis Wave II Webinar Series Sepsis Reassessment Presenters Nova Panebianco, MD Todd Slesinger, MD Fluid Reassessment in Sepsis Todd L. Slesinger, MD, FACEP, FCCM, FCCP, FAAEM Residency Program Director
More informationCapture every aspect of hemodynamic status
Capture every aspect of hemodynamic status Edwards Advanced Technology Swan-Ganz Catheters Hemodynamic Monitoring Systems with Continuous CO, SvO 2, EDV, RVEF, SVR, and SV for Optimal Patient Care The
More informationDisclaimer. Improving MET-based patient care using treatment algorithms. Michael R. Pinsky, MD, Dr hc. Different Environments Demand Different Rules
Michael R. Pinsky, MD - June 29, 26 Improving MET-based patient care using Michael R. Pinsky, MD, Dr hc Department of Critical Care Medicine University of Pittsburgh Disclaimer Michael R. Pinsky, MD is
More informationGoal-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 informationFLUID 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 informationQUICK REFERENCE HEARTWARE HVAD PUMP FLOW INDEX
QUICK REFERENCE HEARTWARE HVAD PUMP FLOW INDEX LOW PULSATILITY, LOW FLOW HVAD waveforms do NOT conform to a single, classic appearance, and are not intended for diagnostic purposes. Waveforms represent
More information福島県立医科大学学術成果リポジトリ. Title laparoscopic adrenalectomy in patie pheochromocytoma. Midori; Iida, Hiroshi; Murakawa, Ma
福島県立医科大学学術成果リポジトリ Examination of the usefulness of no Title variation monitoring for adjusting laparoscopic adrenalectomy in patie pheochromocytoma Isosu, Tsuyoshi; Obara, Shinju; Oha Author(s) Atsuyuki;
More informationObligatory joke. The case for why it matters. Sepsis: More is more. Goal-Directed Fluid Resuscitation 6/1/2013
Obligatory joke Keep your eye on the food. Goal-Directed Fluid Resuscitation Christopher G. Choukalas, MD, MS Department of Anesthesia and Perioperative Care University of California, San Francisco The
More informationEVOLUCIÓN DE LA MONITORIZACIÓN CARDIOVASCULAR EN LA UCI
EVOLUCIÓN DE LA MONITORIZACIÓN CARDIOVASCULAR EN LA UCI Antonio Artigas Critical Care Center Sabadell Hospital CIBER Enfermedades Respiratorias Autonomos University of Barcelona Spain aartigas@tauli.cat
More informationTailored Volume Resuscitation in the Critically Ill is Achievable. Objectives. Clinical Case 2/16/2018
Tailored Volume Resuscitation in the Critically Ill is Achievable Heath E Latham, MD Associate Professor Fellowship Program Director Pulmonary and Critical Care Objectives Describe the goal of resuscitation
More informationImpedance 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 informationTopics 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 informationAdmission of patient CVICU and hemodynamic monitoring
Admission of patient CVICU and hemodynamic monitoring Prepared by: Rami AL-Khatib King Fahad Medical City Pi Prince Salman Heart tcentre CVICU-RN Admission patient to CVICU Introduction All the patients
More informationCARDIAC OUTPUT Monitoring ANDY CAMPBELL JOURNAL CLUB NOV 2011
CARDIAC OUTPUT Monitoring ANDY CAMPBELL JOURNAL CLUB NOV 2011 Is keeping up the pressure enough? It is a source of regret that the measurement of flow is so much more difficult than the measurement of
More informationCogent 2-in-1 Hemodynamic Monitoring System
Cogent 2-in-1 Hemodynamic Monitoring System Minimally invasive and invasive hemodynamic monitoring technologies in a single, lightweight system with wireless communication The flexibility you ve been asking
More informationCrit-Line Monitor. Frequently Asked Questions
Crit-Line Monitor Frequently Asked Questions Crit-Line Monitor Frequently Asked Questions 1 What is the indication for use of the Crit-Line monitor? The Crit-Line Monitor III is used to non-invasively
More informationUseful Ectopics: Case Study. Effects of vasodilation and the diagnostic value of ectopic heartbeats
Effects of vasodilation and the diagnostic value of ectopic heartbeats 83 year old man, weight 66 kg, height 177 cm, BSA 1.82m 2. Closure of colostomy. No cardiac history. Screenshot 1 Baseline at start
More informationProf. Dr. Iman Riad Mohamed Abdel Aal
The Use of New Ultrasound Indices to Evaluate Volume Status and Fluid Responsiveness in Septic Shock Patients Thesis Submitted for partial fulfillment of MD degree in Anesthesiology, Surgical Intensive
More informationSpecial Lecture 10/28/2012
Special Lecture 10/28/2012 HYPERTENSION Dr. HN Mayrovitz Special Lecture 10/28/2012 Arterial Blood Pressure (ABP) - Definitions ABP Review Indirect Oscillographic Method Resistance (R), Compliance (C)
More informationGoal-directed resuscitation in sepsis; a case-based approach
Goal-directed resuscitation in sepsis; a case-based approach Jorge A Guzman, MD, FCCM Head, Section Critical Care Medicine Respiratory Institute Cleveland Clinic Foundation The challenges to managing septic
More informationFunctional Hemodynamic Monitoring and Management A practical Approach
Functional Hemodynamic Monitoring and Management A practical Approach Daniel A. Reuter Center of Anesthesiology and Intensive Care Medicine Hamburg-Eppendorf University Hospital Hamburg, Germany Euronaesthesia
More informationImpedance Cardiography (ICG) Application of ICG for Hypertension Management
Application of ICG for Hypertension Management 1mA @ 100 khz Impedance Cardiography (ICG) Non-invasive Beat-to-beat Hemodynamic Monitoring Diastole Systole Aortic valve is closed No blood flow in the aorta
More informationInvasive Cardiac Output Monitoring and Pulse Contour Analysis. Harshad B. Ranchod Paediatric Intensivist Chris Hani Baragwanath Hospital COPICON 2011
Invasive Cardiac Output Monitoring and Pulse Contour Analysis Harshad B. Ranchod Paediatric Intensivist Chris Hani Baragwanath Hospital COPICON 2011 Introduction The primary goal of haemodynamic monitoring
More informationDESIGNER RESUSCITATION: TITRATING TO TISSUE NEEDS
DESIGNER RESUSCITATION: TITRATING TO TISSUE NEEDS R. Phillip Dellinger MD, MSc, MCCM Professor and Chair of Medicine Cooper Medical School of Rowan University Chief of Medicine Cooper University Hospital
More informationShock and hemodynamic monitorization. Nilüfer Yalındağ Öztürk Marmara University Pendik Research and Training Hospital
Shock and hemodynamic monitorization Nilüfer Yalındağ Öztürk Marmara University Pendik Research and Training Hospital Shock Leading cause of morbidity and mortality Worldwide: dehydration and hypovolemic
More informationThe Comparison of Stroke Volume Variation and Arterial Pressure Based Cardiac Output with Standard Hemodynamic Measurements during Cardiac Surgery
ISPUB.COM The Internet Journal of Anesthesiology Volume 22 Number 2 The Comparison of Stroke Volume Variation and Arterial Pressure Based Cardiac Output with Standard H Liu, M Konia, Z Li, N Fleming Citation
More informationWhat is TAVR? Transcatheter Aortic Valve Replacement
What is TAVR? Transcatheter Aortic Valve Replacement What Are Your Options for Treating Severe Aortic Stenosis? Treatment for aortic stenosis depends on how far your disease has progressed. If your stenosis
More informationHemodynamic monitoring beyond cardiac output
Hemodynamic monitoring beyond cardiac output Prof Xavier MONNET Medical Intensive Care Unit Bicêtre Hospital Assistance publique Hôpitaux de Paris FRANCE Conflicts of interest Lilly GlaxoSmithKline Pulsion
More informationPatient Safety Safe Table Webcast: Sepsis (Part III and IV) December 17, 2014
Patient Safety Safe Table Webcast: Sepsis (Part III and IV) December 17, 2014 Presenters Mark Blaney, RN Regional Nurse Educator CHI Franciscan Health Karen Lautermilch Director, Quality & Performance
More informationDefinition- 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 informationHemodynamic Monitoring in Critically ill Patients in Arthur Simonnet, interne Tuteur : Pr. Raphaël Favory
Hemodynamic Monitoring in Critically ill Patients in 2017 Arthur Simonnet, interne Tuteur : Pr. Raphaël Favory Rationale for Hemodynamic Monitoring Identify the presence of hemodynamic instability Identify
More informationHemodynamic 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 informationPurist? or Pragmatist? Assessment & Management of ICU Volume Status
Assessment & Management of ICU Volume Status 9 th Annual Rocky Mountain Hospital Medicine Symposium Denver, Colorado Paula Dennen, MD Assistant Professor of Medicine Nephrology and Critical Care Medicine
More informationUnderstand the scope of sepsis morbidity and mortality Identify risk factors that predispose a patient to development of sepsis Define and know the
Understand the scope of sepsis morbidity and mortality Identify risk factors that predispose a patient to development of sepsis Define and know the differences between sepsis, severe sepsis and septic
More informationCytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy A 44 year old female undergoing 10 hour Cytoreductive (CRS) procedure followed by Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
More information3/14/2017. Disclosures. None. Outline. Fluid Management and Hemodynamic Assessment Paul Marik, MD, FCCP, FCCM
Fluid Management and Hemodynamic Assessment Paul Marik, MD, FCCP, FCCM Disclosures Stocks Advisory boards Grants Speakers Bureau None Outline Hemodynamic Goals Fluid Resuscitation Historical Perspective
More informationShock, Monitoring Invasive Vs. Non Invasive
Shock, Monitoring Invasive Vs. Non Invasive Paula Ferrada MD Assistant Professor Trauma, Critical Care and Emergency Surgery Virginia Commonwealth University Shock Fluid Pressors Ionotrope Intervention
More informationSepsis Update: Focus on Early Recognition and Intervention. Disclosures
Sepsis Update: Focus on Early Recognition and Intervention Jessie Roske, MD October 2017 Disclosures I have no actual or potential conflict of interest in relation to this program/presentation. I will
More informationTechnique. Technique. Technique. Monitoring 1. Local anesthetic? Aseptic technique Hyper-extend (if radial)
Critical Care Monitoring Hemodynamic Monitoring Arterial Blood Pressure Cannulate artery Uses 2 Technique Sites Locate artery, prep 3 1 Technique Local anesthetic? Aseptic technique Hyper-extend (if radial)
More informationSafe, simple and reliable closed blood sampling for effective patient blood management.9,14
Safe, simple and reliable closed blood sampling for effective patient blood management.9,14 VAMP Systems Venous Arterial Blood Management and Protection Reduce blood loss, hospital-acquired infections,
More informationComputerized PAC Waveform Interpretation
Harvard-MIT Division of Health Sciences and Technology HST.951J: Medical Decision Support, Fall 2005 Instructors: Professor Lucila Ohno-Machado and Professor Staal Vinterbo Computerized PAC Waveform Interpretation
More informationSwan Ganz catheter: Does it still have a role? Daniel De Backer Department of Intensive Care Erasme University Hospital Brussels, Belgium
Swan Ganz catheter: Does it still have a role? Daniel De Backer Department of Intensive Care Erasme University Hospital Brussels, Belgium How can cardiac output be measured? Thermodilution Arterial waveform
More informationFluid responsiveness Monitoring in Surgical and Critically Ill Patients
Fluid responsiveness Monitoring in Surgical and Critically Ill Patients Impact clinique de la Goal-directed-therapy Patrice FORGET, M.D Cliniques universitaires Saint Luc Université catholique de Louvain,
More informationSpecial Lecture 11/08/2013. Hypertension Dr. HN Mayrovitz
Special Lecture 11/08/2013 Hypertension Dr. HN Mayrovitz Arterial Blood Pressure (ABP) Major Factors Summarized Sympathetic Hormones Arteriole MAP ~ Q x TPR + f (V / C) SV x HR Renal SBP Hypertension =
More informationUnderstanding Your Fluid Status During Dialysis and the Crit-Line. IV Monitor
Understanding Your Fluid Status During Dialysis and the Crit-Line IV Monitor IV 1 Understanding Your Fluid Status During Hemodialysis Welcome to understanding your fluid status during hemodialysis. This
More informationIntroduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring
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
More informationImpedance Cardiography (ICG) Application of ICG in Intensive Care and Emergency
Impedance Cardiography (ICG) Application of ICG in Intensive Care and Emergency Aim of haemodynamic monitoring in ICU and ED Detection and therapy of insufficient organ perfusion Answers to common cardiovascular
More informationHemodynamic 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 informationFull Disclosure. The case for why it matters. Goal-directed Fluid Resuscitation
Goal-directed Fluid Resuscitation Christopher G. Choukalas, MD, MS Department of Anesthesia and Perioperative Care University of California, San Francisco I own no stocks Full Disclosure The case for why
More informationEstablishing the New Standard of Care for Inoperable Aortic Stenosis THE PARTNER TRIAL COHORT B RESULTS
Establishing the New Standard of Care for Inoperable Aortic Stenosis THE PARTNER TRIAL COHORT B RESULTS E D W A R D S T R A N S C A T H E T E R H E A R T V A L V E P R O G R A M T H E P A R T N E R T R
More informationEarly detection. Proactive intervention.
Early detection. Proactive intervention. 70% Central Venous Catheter Edwards oximetry central venous catheter (CVC) the first proven CVC with continuous monitoring reveals the true adequacy of tissue oxygenation
More information2015 Facility and Physician Billing Guide Heart Valve Technologies
2015 Facility and Physician Billing Guide Heart Valve Technologies PHYSICIAN BILLING CODES Clinicians use Current Procedural Terminology (CPT 1 ) codes to bill for procedures and services. Each CPT code
More informationFluid responsiveness and extravascular lung water
Fluid responsiveness and extravascular lung water Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France Conflicts of interest Member of the Medical Advisory Board of Maquet/Pulsion
More informationBedside assessment of fluid status
Bedside assessment of fluid status 2nd AKI Academy October 18 th 2014 David Treacher Guy s & St Thomas NHS Trust Assessing the circulation - the 3 key questions v Is my patient adequately filled? v What
More informationPhysiologic Based Management of Circulatory Shock Kuwait 2018
Physiologic Based Management of Circulatory Shock Kuwait 2018 Dr. Yasser Elsayed, MD, PhD Director of the Targeted Neonatal Echocardiography, Point of Care and Hemodynamics Program Staff Neonatologist
More information61% SvO 2. Clarity. Simplified.
61% SvO 2 Clarity Simplified. HemoSphere Advanced Monitoring Platform See advanced hemodynamic parameters with a new level* of clarity. The HemoSphere advanced monitoring platform from Edwards Lifesciences
More informationCardiac 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 informationUsing Functional Hemodynamic Indicators to Guide Fluid Therapy
CE 2.6 HOURS Continuing Education Using Functional Hemodynamic Indicators to Guide Fluid Therapy A more accurate and less invasive way to gauge responsiveness to iv volume replacement. OVERVIEW: Hemodynamic
More informationWhat is TAVR? Transcatheter Aortic Valve Replacement
What is TAVR? Transcatheter Aortic Valve Replacement What Are Your Options for Treating Severe Aortic Stenosis? Treatment for aortic stenosis depends on how far your disease has progressed. If your stenosis
More informationWhere there s flow, there s life. Measuring flow and pressure together, for even greater control
Where there s flow, there s life Measuring flow and pressure together, for even greater control Introducing the CardioQ-ODM+ The CardioQ-ODM+ is the world s first fluid management and cardiac output monitoring
More informationEdwards Critical Care Education. Perioperative Goal-Directed Therapy Protocol Summary
Edwards Critical Care Education Perioperative Goal-Directed Therapy Protocol Summary Issue Date: November 2014 Evidence-based, Perioperative Goal-Directed Therapy (PGDT) protocols Note: This protocol summary
More informationContinuous monitoring of cardiac output: why and how
33rd International Symposium of Intensive Care and Emergency Medicine, Brussels 19.03.-22.03.2013 UNIVERSITÄTSKLINIKUM Schleswig-Holstein Continuous monitoring of cardiac output: why and how Berthold Bein,
More informationFluid Resuscitation and Monitoring in Sepsis. Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS
Fluid Resuscitation and Monitoring in Sepsis Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS Learning Objectives Compare and contrast fluid resuscitation strategies in septic shock Discuss available
More informationEdwards Critical Care Education. Perioperative Goal-Directed Therapy Protocol Summary
Edwards Critical Care Education Perioperative Goal-Directed Therapy Protocol Summary Issue Date: March 2013 Evidence-based, Perioperative Goal-Directed Therapy (PGDT) protocols Note: This protocol summary
More informationPediatric 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 informationCATCH A WAVE.. INTRODUCTION NONINVASIVE HEMODYNAMIC MONITORING 4/12/2018
WAVES CATCH A WAVE.. W I S C O N S I N P A R A M E D I C S E M I N A R A P R I L 2 0 1 8 K E R I W Y D N E R K R A U S E R N, C C R N, E M T - P Have you considered that if you don't make waves, nobody
More informationPerioperative Goal Directed Therapy Improving the Quality of Care for Our Surgical Patients
Perioperative Goal Directed Therapy Improving the Quality of Care for Our Surgical Patients DESIRÉE CHAPPELL, CRNA ERAS TEAM LEAD NORTON AUDUBON HOSPITAL, LOUISVILLE, KY Disclosure Edwards Lifesciences,
More informationJulie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist
Julie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist Objectives Define capnography vs. end tidal CO2 (EtCO 2 ) Identify what normal vs. abnormal EtCO2 values mean and what to do Understand when to
More informationPreload optimisation in severe sepsis and septic shock
Preload optimisation in severe sepsis and septic shock Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris South France Conflicts of interest Member of themedical Advisory Board ofpulsion
More informationPCV and PAOP Old habits die hard!
PCV and PAOP Old habits die hard! F Javier Belda MD, PhD Head of Department Associate Professor Anaesthesia and Critical Care Hospital Clínico Universitario Valencia (SPAIN) An old example TOBACO SMOKING
More informationIV fluid administration in sepsis. Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London
IV fluid administration in sepsis Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London The talk What is septic shock? What are the recommendations? What is the evidence? Do we follow
More informationWhat is. InSpectra StO 2?
What is InSpectra StO 2? www.htibiomeasurement.com What is InSpectra StO 2? Hemoglobin O 2 saturation is measured in three areas: 1) Arterial (SaO 2, SpO 2 ) Assesses how well oxygen is loading onto hemoglobin
More informationHemodynamics. Hemodynamic Monitoring: An Introduction. What is Hemodynamics? Interrelationship of Blood Flow. The study of BLOOD FLOW
Hemodynamics Hemodynamic Monitoring: An Introduction *Brett Fladager, RN, ADN, is a Senior Staff Nurse in SICU at Hennepin County Medical Center 1. Define Hemodynamics 2. Discuss Normal and Abnormal Hemodynamics
More informationCardioplegia Circuit Products { ANTEGRADE}
Cardioplegia Circuit Products { ANTEGRADE} Antegrade cannulae are designed to deliver cardioplegia solution to the heart via the coronary ostia in the normal direction of blood flow (antegrade perfusion).
More informationEdwards Critical Care Education. Perioperative Goal-Directed Therapy Protocol Summary
Edwards Critical Care Education Perioperative Goal-Directed Therapy Protocol Summary Issue Date: March 2013 Evidence-based, Perioperative Goal-Directed Therapy (PGDT) protocols Note: This protocol summary
More informationThe Septic Patient. Dr Arunraj Navaratnarajah. Renal SpR Imperial College NHS Healthcare Trust
The Septic Patient Dr Arunraj Navaratnarajah Renal SpR Imperial College NHS Healthcare Trust Objectives of this session Define SIRS / sepsis / severe sepsis / septic shock Early recognition of Sepsis The
More informationPerioperative Fluid Management in ERPs
Perioperative Fluid Management in ERPs Robert H. Thiele, M.D. Assistant Professor University of Virginia First Do No Harm Intravenous fluids should be considered a pharmacotherapeutic agent Just like all
More informationDepartment of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS
Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS a mismatch between tissue perfusion and metabolic demands the heart, the vasculature
More informationReview Article. Interactive Physiology in Critical Illness : Pulmonary and Cardiovascular Systems. Introduction
310 Indian Deepak J Physiol Shrivastava Pharmacol 2016; 60(4) : 310 314 Indian J Physiol Pharmacol 2016; 60(4) Review Article Interactive Physiology in Critical Illness : Pulmonary and Cardiovascular Systems
More informationVentriculo-arterial coupling and diastolic elastance. MasterclassIC Schiermonnikoog 2015
Ventriculo-arterial coupling and diastolic elastance MasterclassIC Schiermonnikoog 2015 Ventriculo-arterial coupling Dynamic interaction between heart and systemic circulation (modulation of compliance
More informationCritical Care Nursing Program August to November, 2015 Full-time Lesson A13 Pumping and Perfusion III Basic Hemodynamic Monitoring
Critical Care Nursing Program August to November, 2015 Full-time Lesson A13 Pumping and Perfusion III Basic Hemodynamic Monitoring August 2015 RN Professional Development Centre Page 1 Lesson Thirteen
More informationCath Lab Essentials: Basic Hemodynamics for the Cath Lab and ICU
Cath Lab Essentials: Basic Hemodynamics for the Cath Lab and ICU Ailin Barseghian El-Farra, MD, FACC Assistant Professor, Interventional Cardiology University of California, Irvine Department of Cardiology
More informationSedLine Sedation Monitor
SedLine Sedation Monitor Quick Reference Guide Not intended to replace the Operator s Manual. See the SedLine Sedation Monitor Operator s Manual for complete instructions, including warnings, indications
More informationContinuous and noninvasive arterial blood pressure monitoring
Continuous and noninvasive arterial blood pressure monitoring Pr. Jean-Luc Fellahi fellahi-jl@chu-caen.fr Pôle Réanimations-Anesthésie-SAMU, CHU de Caen UFR de Médecine, EA4650, Université de Caen Basse-Normandie
More informationCardiovascular Management of Septic Shock
Cardiovascular Management of Septic Shock R. Phillip Dellinger, MD Professor of Medicine Robert Wood Johnson Medical School/UMDNJ Director, Critical Care Medicine and Med/Surg ICU Cooper University Hospital
More informationLess Invasive, Continuous Hemodynamic Monitoring During Minimally Invasive Coronary Surgery
Less Invasive, Continuous Hemodynamic Monitoring During Minimally Invasive Coronary Surgery Oliver Gödje, MD, Christian Thiel, MS, Peter Lamm, MD, Hermann Reichenspurner, MD, PhD, Christof Schmitz, MD,
More information