HEMODYNAMIC MONITORING

Ita Yuanita

INTRODUCTION
Hemodynamic monitoring is necessary to

assess and manage shock Information obtained through hemodynamic monitoring: Cardiovascular perfomance (right and left ventricular function) Changes in hemodynamic status and organ perfusion Pharmacologic and nonpharmacologic therapy Prognosis

Cardiovascular System
Vascular network of > 60,000 miles

Circulating 8 L of blood every day

Provides O2 to over 100 trillion cells
Right side unoxygenated blood to the lungs Left side oxygenated blood systemically

Vasculature
Arteries carry blood away from the heart Veins carry blood to the heart

Capillaries responsible for exchange of nutrients

and gases

Determinants of Cardiovascular Function

Cardiac output (CO) = Heart rate (HR) x Stroke volume

(SV)
Volume of blood ejected from the left ventricle per unit time

(L/min)
HR is regulated by the sympathetic nervous system SV is the volume of blood ejected by the ventricles during

systole
Three factors influencing stroke volume
Preload (LVEDV/the left ventricular end diastolic volume or

LVEDP/ Left ventricular end diastolic pressure) stretching of the LV muscle fibers after diastole Afterload (SVR) force left ventricle has to overcome to eject blood Contractility (Inotropy) force and velocity of muscular contraction

Determinants of Cardiovascular Function

Preload
Determines the strength of ventricularcontraction

Stroke volume
Dependent upon EDV (end diastolic volume ),

pleural pressure, vascular compliance, and vascular resistance

Contractility

Hemodynamic Monitoring
Invasive
Eliminates potential for error due to measurement

technique Assessment is not inhibited in low-flow states Recommended for all ICU patients with cardiovascular instability In 50% of shock patients non-invasive methods underestimate BP by > 30 mmHg

Non Invasive monitoring

Vital signs HR, BP, and RR Cappilary refill Time (CRT) Level of consciousness

Arterial oxygen saturation

Transthoracic echocardiography

INVASIVE HEMODYNAMIC MONITORING

Eliminates potential for error due to

measurement technique Assessment is not inhibited in low-flow states Recommended for all ICU patients with cardiovascular instability In 50% of shock patients non-invasive methods underestimate BP by > 30 mmHg

Invasive Hemodynamic Monitoring

Arterial catheter
Inserted into radial or brachial artery Used for hemodynamic monitoring MAP driving pressure for peripheralblood flow

MAP = [SBP + 2(DBP)] / 3 Central venous catheter

Administration of IVF and medications Central Venous Pressure CVP = RAP or RVEDP

Assesses fluid status

Pulmonary Artery Catheter

Hemodynamic data
Volume status Ventricular function Oxygen delivery / consumption

Fluid / medication administration

Complications of PA Catheters
Infection

Pulmonary infarction
Pulmonary thrombosis Arrhythmias Intracardiac damage Pneumothorax Arterial-venous fistulas Pulmonary artery perforation