Hemodynamic monitoring
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Hemodynamic monitoring involves measuring the motion of blood through the body and interpreting how the cardiovascular system is performing. The goal is optimizing oxygen delivery. Key metrics include cardiac output, arterial and venous oxygen levels, and oxygen delivery and consumption. Common monitoring methods are non-invasive blood pressure, arterial catheters, central venous pressure, pulmonary artery catheters, and pulse oximetry. Each method has advantages and limitations for assessing hemodynamics and tissue oxygenation. Careful interpretation of the data is important for clinical decision making.
![Oxygen Delivery is the GoalOxygen Delivery is the Goal
Oxygen DeliveryOxygen Delivery
DO2 = CO x CaO2 x 10DO2 = CO x CaO2 x 10
CO = HR x SVCO = HR x SV
CaO2 = [1.34 x Hb x SaO2 ] + [0.003 xCaO2 = [1.34 x Hb x SaO2 ] + [0.003 x
PaO2]PaO2]
Oxygen ConsumptionOxygen Consumption
CVO2 = [1.34 x Hb x SvO2 ] + [.003 xCVO2 = [1.34 x Hb x SvO2 ] + [.003 x
PVO2]PVO2]
VO2 = CO x 3(CaO2 –CvO2 ) x 10VO2 = CO x 3(CaO2 –CvO2 ) x 10](https://image.slidesharecdn.com/hemodynamicmonitoring-130509030128-phpapp02/85/Hemodynamic-monitoring-3-320.jpg)
Hemodynamic monitoring
- 2. IntroductionIntroduction Hemodynamic:Hemodynamic: – study of the motion of blood through the bodystudy of the motion of blood through the body – Measurement & interpretation of biologicalMeasurement & interpretation of biological systems that describe performance of thesystems that describe performance of the cardiovascular systemcardiovascular system
- 3. Oxygen Delivery is the GoalOxygen Delivery is the Goal Oxygen DeliveryOxygen Delivery DO2 = CO x CaO2 x 10DO2 = CO x CaO2 x 10 CO = HR x SVCO = HR x SV CaO2 = [1.34 x Hb x SaO2 ] + [0.003 xCaO2 = [1.34 x Hb x SaO2 ] + [0.003 x PaO2]PaO2] Oxygen ConsumptionOxygen Consumption CVO2 = [1.34 x Hb x SvO2 ] + [.003 xCVO2 = [1.34 x Hb x SvO2 ] + [.003 x PVO2]PVO2] VO2 = CO x 3(CaO2 –CvO2 ) x 10VO2 = CO x 3(CaO2 –CvO2 ) x 10
- 4. Methods of Hemodynamic MonitoringMethods of Hemodynamic Monitoring Arterial Blood PressureArterial Blood Pressure – Non-invasiveNon-invasive – Direct arterial pressure measurementDirect arterial pressure measurement Central Venous PressureCentral Venous Pressure The Pulmonary Artery CatheterThe Pulmonary Artery Catheter Cardiac Output MeasurementCardiac Output Measurement Tissue OxygenationTissue Oxygenation
- 5. Non-invasive Blood Pressure MonitoringNon-invasive Blood Pressure Monitoring
- 6. Limitations of Non-invasive BloodLimitations of Non-invasive Blood Pressure MonitoringPressure Monitoring Cuff must be placed correctly and must beCuff must be placed correctly and must be appropriately sizedappropriately sized – Auscultatory method is very inaccurateAuscultatory method is very inaccurate Korotkoff sounds difficult to hearKorotkoff sounds difficult to hear – Significant underestimation in low-flow (i.e.Significant underestimation in low-flow (i.e. shock) statesshock) states Oscillometric measurements alsoOscillometric measurements also commonly inaccurate (> 5 mm Hg offcommonly inaccurate (> 5 mm Hg off directly recorded pressures)directly recorded pressures)
- 7. Direct Arterial Blood PressureDirect Arterial Blood Pressure MeasurementMeasurement
- 8. Indications for Arterial CatheterizationIndications for Arterial Catheterization Need for continuous blood pressureNeed for continuous blood pressure measurementmeasurement – Hemodynamic instabilityHemodynamic instability – Vasopressor requirementVasopressor requirement – Respiratory failureRespiratory failure Frequent arterial bloodFrequent arterial blood gas assessmentsgas assessments Most common locations: radial, femoral,Most common locations: radial, femoral, axillary, and dorsalis pedisaxillary, and dorsalis pedis
- 9. Complications of Arterial CatheterizationComplications of Arterial Catheterization HemorrhageHemorrhage HematomaHematoma ThrombosisThrombosis Proximal or distal embolizationProximal or distal embolization PseudoaneurysmPseudoaneurysm InfectionInfection
- 10. Limitations of Arterial CatheterizationLimitations of Arterial Catheterization Pressure does not accurately reflect flowPressure does not accurately reflect flow when vascular impedance is abnormalwhen vascular impedance is abnormal Systolic pressure amplificationSystolic pressure amplification – Mean pressure is more accurateMean pressure is more accurate Recording artifactsRecording artifacts – UnderdampingUnderdamping – OverdampingOverdamping
- 11. Central Venous CatheterizationCentral Venous Catheterization Central venous pressureCentral venous pressure – Right atrial (superior vena cava) pressureRight atrial (superior vena cava) pressure – Limited by respiratory variation and PEEPLimited by respiratory variation and PEEP Central venous oxygen saturationCentral venous oxygen saturation – SCvO2SCvO2 – Correlates with SMVO2 assuming stableCorrelates with SMVO2 assuming stable cardiac functioncardiac function – Goal-directed resuscitation in severe sepsisGoal-directed resuscitation in severe sepsis and septic shock (Rivers, et al)and septic shock (Rivers, et al)
- 12. Central Venous CanulationCentral Venous Canulation IndicationsIndications – Measure central venous pressureMeasure central venous pressure – Access for resuscitationAccess for resuscitation – Selected drug administrationSelected drug administration – Placement of pulmonary artery catheterPlacement of pulmonary artery catheter ComplicationsComplications – Hematoma/vessel injury/blood lossHematoma/vessel injury/blood loss – Pneumothorax/hemothoraxPneumothorax/hemothorax – Cardiac arrhythmiasCardiac arrhythmias – InfectionInfection
- 13. LevelingLeveling
- 15. Central Venous Pressure WaveformCentral Venous Pressure Waveform
- 16. The Pulmonary Artery CatheterThe Pulmonary Artery Catheter HJC Swan and Santa Monica Bay sailboatsHJC Swan and Santa Monica Bay sailboats (NEJM 1970)(NEJM 1970) Widespread use in critically ill patientsWidespread use in critically ill patients – Remains controversialRemains controversial – Lack of prospective, randomized trialsLack of prospective, randomized trials – PAC data are only as good as the clinicians’PAC data are only as good as the clinicians’ interpretation and applicationinterpretation and application Measures CVP, PAP, PAOP, Cardiac Index andMeasures CVP, PAP, PAOP, Cardiac Index and SVO2SVO2 Approximately 1 million PACs placed annuallyApproximately 1 million PACs placed annually
- 17. Pulmonary Artery CatheterPulmonary Artery Catheter
- 18. Pulmonary Artery Catheter InsertionPulmonary Artery Catheter Insertion
- 19. Normal Hemodynamic ValuesNormal Hemodynamic Values
- 20. Pulse OximetryPulse Oximetry Estimates HbOEstimates HbO22 as SpOas SpO22 HR displayed shoud be = pulse rateHR displayed shoud be = pulse rate
- 22. Source of ErrorSource of Error Physiologic/anatomicalPhysiologic/anatomical –Vasoconstriction/poor perfusionVasoconstriction/poor perfusion –Abnormal hemoglobinAbnormal hemoglobin –Skin pigmentationSkin pigmentation ExternalExternal –Motion of sensorMotion of sensor –Extraneous lightExtraneous light