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Hemodynamic Monitoring for the Respiratory Therapist. Jane Reynolds, MS, RN, RRT. Definition of terms. Preload – amount of blood in the ventricle before contraction – E nd d iastolic v olume EDV determines the amount of ‘stretch’ that is placed on the myocardial muscle
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Hemodynamic Monitoring for the Respiratory Therapist Jane Reynolds, MS, RN, RRT
Definition of terms • Preload– amount of blood in the ventricle before contraction – End diastolic volume • EDV determines the amount of ‘stretch’ that is placed on the myocardial muscle • That ‘stretch’ determines the strength of the next contraction • The strength of the contraction determines how much blood is pumped out of the ventricle during the next systole ‘stroke volume’ • The stroke volume determines the blood pressure and perfusing pressures
Definition of terms • Afterload -resistance to blood flow from the ventricle; work that must be done to pump blood from the ventricle to the circulation • Resistance determined by size of valve opening, blood viscosity and blood pressure in pulmonary or systemic circulation • Work – is the oxygen consumed by the myocardium to overcome the resistance to flow
Preload to RV Afterload to RV Preload to LV Preload to LV Afterload to LV Normal Circulatory Pressures 5 3 2 3 1
Case Study 1 • An 18 year old white male was brought to the ED by CFD after being rescued from his car following a high speed collision with a parked truck. He is conscious, c/o of chest pain and is anxious. He was wearing his seat belt but still hit his chest on the steering wheel. His vital signs are: T 37, P 113, RR 23, B/P 100/ 70. CT scan of chest was unremarkable and he was brought to SICU for observation. He continued to have fluctuations in his blood pressure. A pulmonary artery catheter was placed.
Case Study 2 A 72 year old white female was admitted to the MICU with an exacerbation of COPD. She has emphysema and chronic bronchitis and a 40 pack year history of cigarette smoking. Breath sounds are bilaterally diminished, crackles and rhonchi. She has JVD and pedal edema. A pulmonary artery catheter was placed as she had sustained hypotension and SOB. Her VS are: T 37, P118, RR 32, B/P 150/90, FiO2 .28, HB 22 Gm%.
Case Study 3 A 25 year Hispanic male was admitted to the SICU after a thoracotomy for repair of his aorta following a gun shot wound to his chest. He has bilateral chest tubes. He is intubated and receiving full ventilatory support. His chest tube drainage for the last hour was 400 ml. He has bloody sputum and urine. His last CaO2 was 10.4 volumes% with a PaO2 of 110 and saturation of 95%. VS T 36, P148, RR 14, B/P 65/44.
Case Study 4 A 52 year old white male with shortness of breath and chest pain was admitted to the ED. ECG showed ST elevation in 4 leads and his cardiac enzymes were markedly elevated. His vital signs were stable, SpO2 on NC at 2 LPM was 95%. He was taken to the cardiac cath lab and a diagnostic cardiac angiogram revealed 99% occlusion of his LAD. A coronary stent was placed and 15 minutes post intervention he began complaining again of severe SOB and chest pain. He was taken back to the cath lab. A pulmonary artery catheter was placed. A left heart catheterization revealed progression of the MI. His LVEDP is 32 and an intra aortic balloon was placed and counter pulsation started at 1:1.
Case Study 5 A 55 year old AA male was admitted to the MICU with acute SOB, cough, HTN and hypoxemia. He is oliguric and has required hemodialysis for the past 2 years. He is depressed and has not been following his dietary and fluid restrictions and has skipped his last 2 dialysis appointments. His VS are now T 37, P118, RR 35, B/P 200/135. He is receiving oxygen via venturi mask, FiO2 50%. He has a pulmonary artery catheter in place to monitor his cardiac status.
Case Study 6 A 36 year old female was admitted to the ED with a CC of SOB and chest pain. She has no significant PMH, she does not smoke. She says that she hurt her ankle about two weeks ago and never went to the doctor about it. It is very painful and she has been almost immobilized for the past two weeks because it is just too painful to walk on. She has a cough and says her SOB came on rather suddenly after she went down to her basement to put some clothes in the laundry this morning. She is tachypneic, her MV is 12 LPM.
Questions?? Thank you! You were great!!
Left-Sided Heart Failure • Pulmonary congestion occurs when left ventricle cannot pump well • Dyspnea upon exertion, orthopnea, and paroxysmal nocturnal dyspnea • Oliguria
Right-Sided Heart Failure • Congestion of viscera and peripheral tissues when right ventricle fails • Jugular vein distention • Dependent edema • Hepatomegaly • Ascites • Weakness, anorexia, and nausea • Weight gain
