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PulseCO Monitoring System

PulseCO Monitoring System. Charles E. Smith, MD, FRCPC Professor of Anesthesia MetroHealth Medical Center Case Western Reserve University Cleveland, Ohio. Estimates of Preload. Clinical: BP, HR, capillary refill, urine Postural changes CVP PAC Echo. Systolic Pressure Variation.

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PulseCO Monitoring System

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  1. PulseCO Monitoring System Charles E. Smith, MD, FRCPC Professor of Anesthesia MetroHealth Medical Center Case Western Reserve University Cleveland, Ohio

  2. Estimates of Preload • Clinical: BP, HR, capillary refill, urine • Postural changes • CVP • PAC • Echo

  3. Systolic Pressure Variation • Difference between maximal + minimal values of systolic BP during PPV •  down: ~ 5 mm Hg due to  venous return • SPV > 15 mm Hg, or  down > 15 mm Hg: • highly predictive of hypovolemia Marik: Anaesth Intensive Care 1993;21:405. Coriat: Anesth Analg 1994;78:46

  4. Gardner, in Critical Care, 3rd ed. Civetta. 1997, p 851

  5. Pulse Contour Analysis • 1. Transform BP waveform into volume – time waveform • 2. Derive uncalibrated SV • SV x HR = CO • 3. Calibrate using Li indicator [LidCO], Swan Ganz, or known SV from ejection fraction (Echo) • Assumptions: • PPV induces cyclical changes in SV • Changes in SV results in cyclical fluctuation of BP or SPV Linton R: 1997, 1998, 2000

  6. PulseCO SPV + SV • Predicts SV  in response to volume after cardiac surgery + in ICU[Reuter: BJA 2002; 88:124; Michard: Chest 2002; 121:2000] • Similar estimates of preload v. echo during hemorrhage[Preisman: BJA 2002; 88: 716] • Helpful in dx of hypovolemia after blast injury [Weiss: J Clin Anesth 1999; 11:132]

  7. Calibration Using EF • Obtain uncalibrated SV tracing from PulseCO monitor • Estimate EF from preop echo or baseline cardiac status [usual SV approx 0.7-1 ml/kg] • Enter calibration factor on monitor

  8. Calibration Using EF Example 1: uncalibrated SV reading 140 ml/beat; 70 kg pt with normal EF; calibration factor = 0.5 Example 2: uncalibrated SV reading 100 ml/beat; 70 kg pt with DCM; calibration factor = 0.3

  9. Pitfalls with SPV + SV • Inaccurate if • AI • IABP • Problems if • pronounced peripheral arterial vasoconstriction • damped art line • Arrhythmias

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