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Hemodynamic monitoring In ACS I like SWAN

Hemodynamic monitoring In ACS I like SWAN. Rao R. Ivatury M.D. Hemodynamic monitoring In ACS. assessment and optimization of: Preload Contractility Afterload is essential to restoring end-organ perfusion and function. Hemodynamic monitoring In ACS. IAH. Intra-thoracic pressure.

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Hemodynamic monitoring In ACS I like SWAN

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  1. Hemodynamic monitoring In ACS I like SWAN Rao R. Ivatury M.D.

  2. Hemodynamic monitoring In ACS assessment and optimization of: Preload Contractility Afterload is essential to restoring end-organ perfusion and function

  3. Hemodynamic monitoring In ACS IAH Intra-thoracic pressure Preload Contractility Afterload Cardiac Output

  4. Hemodynamic monitoring In ACS Bloomfield et al, 1996

  5. Hemodynamic monitoring In ACS Bloomfield et al, 1996

  6. Hemodynamic monitoring In ACS Bloomfield et al, 1996

  7. Hemodynamic monitoring In ACS RVEDVI = SVI / RVEF RVEDVI : an accurate indicator of preload in a variety of patient populations and disease processes

  8. Hemodynamic monitoring in ACS significant correlation between RVEDVI and CI and a lack of correlation between PAOP or CVP and CI. PAOP measurements provide potentially misleading information regarding preload status in 52% of critically ill patients Durham, 1995 Deibel, 1997

  9. Hemodynamic monitoring In ACS • IAP decreased with decompression • RVEDVI improved independent of CI • Correlated better (p < 0.01) with CI than PAOP did • PAOP correlated significantly with IAP Chang et al, 1998

  10. Hemodynamic monitoring In ACS • 20 surgical and trauma patients with IAH and abdominal decompression • Multiple regression analysis : • cardiac index correlated significantly better with RVEDVI (r = 0.69) than with PAOP (r = -0.27) or CVP (r = -0.28) during resuscitation after open abdominal decompression (p < 0.0001). Cheatham et al, 1999

  11. Hemodynamic monitoring in ACS • 23 patients who developed ACS and decompressed • The ACS and non-ACS patients were similar with ISS • The severity of pre-ICU shock greater in the ACS patients • Patients who developed ACS received more blood transfusions • (11 +/- 2 versus 2 +/- 0.2 units; P<0.05) and crystalloids • (13 +/- 2 versus 4 +/- 0.3 L; P<0.05). • PACWP increased more in the ACS patients (20 +/- 1.5 versus • 15 +/- 0.5 mm Hg; P<0.05). • CI did not (3.2 +/- 0.2 versus 4.2 +/- 0.1 L/min/m(2); P<0.05) • ACS patients developed > PgCO2 levels • Conventional preload directed resuscitation to enhance • cardiac function is not effective in patients with impending ACS Balogh, 2003

  12. Hemodynamic monitoring In ACS CCO monitoring provides a minute-by-minute assessment of patient response to therapeutic interventions CCO measurements have been shown to correlate with intermittent thermodilution, indocyanine green dye dilution, radionuclide ventriculography, biplane angiography, and 2-D echocardiography

  13. A significant correlation was found between IAP and Ppl with approximately 80% of the IAP being transmitted to the intrathoracic compartmentIn patients with IAH, the simple calculation of subtracting half the IAP from PAOPee or CVPee may provide a rapid bedside estimate of transmural filling pressure. Hemodynamic monitoring In ACS Malbrain, 2003

  14. Hemodynamic monitoring In ACS Constantly changing ventricular function and compliance. As ventricular function changes, the patient "shifts" from one Starling curve to another with identification of a new, optimal plateau end-diastolic volume as a resuscitation endpoint.

  15. RVEF 0.20 RVEDVI RVEF 0.30 RVEF 0.40 Cardiac Index Hemodynamic monitoring In ACS Preload Inotropes Decompression Cheatham, 2000

  16. Hemodynamic approach In ACS Preload RVEF-corrected RVEDVI Decompression Based on APP Inotropes After optimizing preload

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