Dana Oakes, BA, RRT NPS Author/Speaker Cardiopulmonary System Main Purpose Main Function Main Goal Oxygen Delivery Adequate Perfusion (deliver adequate oxygen and nutrients; remove metabolic waste) Tissue Oxygenation Respiratory Therapist s Job USED TO BE: Get O 2 into lungs and hope Cardiovascular System picks it up and delivers NOW: Ensure that O 2 not only gets to the lungs, but is effectively delivered to the tissue information on material, see RESPIRATORYBOOKS.COM 1
Monitoring! Pulmonary: Monitor O 2 from air to circulation Cardiovascular: Monitor O 2 from circulation to tissue (Psst... This is Hemodynamic Monitoring!) Hemodynamics The study of blood flow to the body Hemodynamic Monitoring The monitoring of the blood flow to the body Hemo Monitoring: Purpose 1. Assess blood flow Ensure adequacy of tissue perfusion/oxygenation 2. Early detection of life threatening derangements of vital functions 3. Titrate therapy Ensure adequacy of tissue perfusion/oxygenation and correct derangements information on material, see RESPIRATORYBOOKS.COM 2
What do all people die from? Hypoxia! #1 cause of death in ICU? Multi System Organ Dysfunction (due to hypoxia) RTs can be and should be the first to detect hypoxia Oxygen Delivery O 2 Supply FIO 2 % Patm (conc) PIO 2 PAO 2 PaO 2 O 2 Transport VE VT RR Monitor FIO 2 VE VT RR Alv air Eq ABG PaO 2 SaO 2 SaO 2 Air Circula on PaO 2 PaO 2 / FIO 2 (P/F ratio) (V/Q) PA ao 2 (A a gradient) PaO 2 /PAO 2 (a/a ratio) information on material, see RESPIRATORYBOOKS.COM 3
Monitor O2 Reserve O2 O2 Transport Supply ScvO 2 CvO 2 CO CVC Preload CVP Waveform PAC PAP PASP PADP PAMP PCWP (PAWP) (PAOP) Waveforms Contractility Afterload SV PVR O 2 insufficiency Determined if & when: VO 2 > DO 2 = shock (hypoxia) Hypoxia Anaerobic Metabolism O2 Debt Multi Organ Dysfunction Inflammatory Response Cell Dysfunction Non Invasive Minimally Invasive Invasive Monitoring CO (a challenge) information on material, see RESPIRATORYBOOKS.COM 4
Non Invasive Signs of CO Sign BP HR (maybe ) Pulse Strength Capillary Refill Skin Temperature Urinary Output (UO) Mental Status Skin Color Lactate Less Specific: RR, ECG ssue perfusion/oxygena on = CO Pale = CO = CO Pulmonary Artery Catheter (Swan Ganz) Measured or Derived Parameters (mostly left heart values) CO CI CVP HR PADP PASP PAWP (LAP, LVEDP) RAP (RVEDP) PvCO 2 PvCO 2 PvO 2 PvO 2 phv CvO 2 LV (function, curve) LVSW LVSWI PAMP PVR PVRI RVSW RVSWI SV SVI SW SWI a vdo 2 Ca vo 2 DO 2 MDO 2 MVO 2 O 2 ER QS/QT SVR SVRI VO 2 CPP Reflects metabolism SaO 2 = O 2 metabolism Norm = 75% (range 60 80%) < 50% = anaerobic metabolism and global hypoxia Goal = 70% information on material, see RESPIRATORYBOOKS.COM 5
Mechanical Ven la on may CO 1. venous return (no spontaneous ventilation) Spontaneous ven la on = venous return 2. Blockage of pulmonary blood flow lung vol (>FRC), PIT, PVR, RV ou low, EF, RVEDV, CVP References Pulmonary Monitoring Hemodynamic Monitoring RespiratoryUpdate.com information on material, see RESPIRATORYBOOKS.COM 6