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Haemodynamic Monitoring

Haemodynamic Monitoring. Theory and Practice. Haemodynamic Monitoring. Physiological Background Monitoring Optimising the Cardiac Output Measuring Preload Introduction to PiCCO Technology Practical Approach Fields of Application Limitations. Physiological Background.

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Haemodynamic Monitoring

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  1. Haemodynamic Monitoring Theory and Practice

  2. Haemodynamic Monitoring Physiological Background Monitoring Optimising the Cardiac Output Measuring Preload Introduction to PiCCO Technology Practical Approach Fields of Application Limitations

  3. Physiological Background Task of the circulatory system Pflüger 1872: ”The cardio-respiratory system fulfils the physiological task of ensuring cellular oxygen supply” Goal Reached? Yes OK Assessment of oxygen supply and demand What is the problem? Diagnosis No Therapy Uni Bonn

  4. Physiological Background Processes contributing to cellular oxygen supply Aim: Optimal Tissue Oxygenation Direct Control Indirect Pulmonary gas exchange Macrocirculation Microcirculation Cell function Volume Catecholamines Oxygen Utilisation Cells / Mitochondria Oxygen Absorption Lungs Oxygen Transportation Blood Oxygen Delivery Tissues Oxygen carriers Ventilation

  5. Physiological Backgound Organ specific differences in oxygen extraction SxO2 in % Oxygen delivery must always be greater than consumption! modified from: Reinhart K in: Lewis, Pfeiffer (eds): Practical Applications of Fiberoptics in Critical Care Monitoring, Springer Verlag Berlin - Heidelberg - NewYork 1990, pp 11-23

  6. Physiological Background Dependency of Oxygen Demand on delivery Behaviour of oxygen consumption and the oxygen extraction rate with decreasing oxygen supply Oxygen consumption Oxygen extraction rate DO2-independent area DO2- dependent area Decreasing Oxygen Supply DO2: Oxygen Delivery

  7. Physiological Background Determinants of Oxygen Delivery and Consumption Central role of the mixed venous oxygen saturation CO SaO2 Delivery DO2: DO2 = CO x Hb x 1.34 x SaO2 Hb CO: Cardiac Output Hb: Haemoglobin SaO2: Arterial Oxygen Saturation SvO2: Mixed Venous Oxygen Saturation DO2: Oxygen Delivery VO2: Oxygen Consumption

  8. Physiological Background Determinants of Oxygen Delivery and Consumption Central role of mixed central venous oxygen saturation CO SaO2 Delivery DO2: DO2 = CO x Hb x 1.34 x SaO2 Consumption VO2: VO2 = CO x Hb x 1.34 x (SaO2 -  SvO2) Hb S(c)vO2 SvO2 Mixed Venous Saturation SvO2 CO: Cardiac Output Hb: Haemoglobin SaO2: Arterial Oxygen Saturation SvO2: Mixed Venous Oxygen Saturation DO2: Oxygen Delivery VO2: Oxygen Consumption

  9. Physiological Background Oxygen delivery and its influencing factors DO2 = CaO2 x CO = Hb x 1.34 x SaO2 x CO Transfusion • Transfusion CO: Cardiac Output Hb: Haemoglobin SaO2: Arterial Oxygen Saturation CaO2: Arterial Oxygen Content

  10. Physiological Background Oxygen delivery and its influencing factors DO2 = CaO2 x CO = Hb x 1.34 x SaO2 x CO Ventilation • Transfusion • Ventilation CO: Cardiac Output Hb: Haemoglobin SaO2: Arterial Oxygen Saturation CaO2: Arterial Oxygen Content

  11. Physiological Background Oxygen delivery and its influencing factors DO2 = CaO2 x CO = Hb x 1.34 x SaO2 x CO Volume Catecholamines • Transfusion • Ventilation • Volume • Catecholamines CO: Cardiac Output Hb: Haemoglobin SaO2: Arterial Oxygen Saturation CaO2: Arterial Oxygen Content

  12. Physiological Background Assessment of Oxygen Delivery Supply DO2 = CO x Hb x 1.34 x SaO2 SaO2 CO, Hb Oxygen Absorption Lungs Oxygen Transport Blood Oxygen Delivery Tissues Oxygen Utilization Cells / Mitochondria CO: Cardiac Output; Hb: Hemoglobin; SaO2: Arterial Oxygen Saturation

  13. Physiological Background Assessment of Oxygen Delivery Supply Monitoring the CO, SaO2 and Hb is essential! SaO2 CO, Hb Oxygen Absorption Lungs Oxygen Transport Blood Oxygen Delivery Tissues Oxygen Utilization Cells / Mitochondria CO: Cardiac Output; Hb: Haemoglobin; SaO2: Arterial Oxygen Saturation

  14. Physiological Background Assessment of Oxygen Delivery Supply Monitoring the CO, SaO2 and Hb is essential! SaO2 CO, Hb Oxygen Absorption Lungs Oxygen Transport Blood Oxygen Utilization Cells / Mitochondria Oxygen Delivery Tissues SvO2 VO2 = CO x Hb x 1.34 x (SaO2 – SvO2) Consumption CO: Cardiac Output; Hb: Haemoglobin; SaO2: Arterial Oxygen Saturation

  15. Physiological Background Assessment of Oxygen Delivery Supply Monitoring CO, SaO2 and Hb is essential SaO2 CO, Hb Oxygen Absorption Lungs Oxygen Transport Blood Oxygen Delivery Tissues Oxygen Utilization Cells / Mitochondria SvO2 Monitoring the CO, SaO2 and Hb does not give information re O2-consumption! Consumption CO: Cardiac Output; Hb: Haemoglobin; SaO2: Arterial Oxygen Saturation

  16. Physiological Background Balance of Oxygen Delivery and Consumption The adequacy of CO and SvO2 is affected by many factors Older Age Body weight /height Current Medical History Previous Medical History General Factors Microcirculation Disturbances Volume status Tissue Oxygen Supply Oxygenation / Hb level Situational Factors

  17. Physiological Background Extended Haemodynamic Monitoring Monitoring Optimisation O2 supply O2 consumption Therapy

  18. Physiological Background Summary and Key Points • The purpose of the circulation is cellular oxygenation • For an optimal oxygen supply at the cellular level the macro and micro-circulation as well as the pulmonary gas exchange have to be in optimal balance • Next to CO, Hb and SaO2 is SvO2 which plays a central role in the assessment of oxygen supply and consumption • No single parameter provides enough information for a full assessment of oxygen supply to the tissues.

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