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Johannes J. van Lieshout, Wilbert A. Wesselink, Berend E. Westerhof

European Society for Computing and Technology in Anesthesia and Intensive Care 2010 Non-invasive pulse contour cardiac output by Nexfin technology. Johannes J. van Lieshout, Wilbert A. Wesselink, Berend E. Westerhof Special Medical Care, Dpt Internal Medicine

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Johannes J. van Lieshout, Wilbert A. Wesselink, Berend E. Westerhof

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  1. European Society for Computing and Technologyin Anesthesia and Intensive Care 2010Non-invasive pulse contour cardiac output by Nexfin technology Johannes J. van Lieshout, Wilbert A. Wesselink, Berend E. Westerhof Special Medical Care, Dpt Internal Medicine Laboratory for Clinical Cardiovascular Physiology, Center for Heart Failure Research Academic Medical Center Amsterdam

  2. Casus

  3. Casus

  4. Non-invasive pulse contour cardiac output - Outline • Continuous Finger Arterial Pressure • From Finger Pressure to Flow

  5. Clinical standard

  6. late 1970s:Non-Invasive Blood pressure Device (NIBD) 9/00 JJvL 05/06 JJvL

  7. 9/00 JJvL 05/06 JJvL

  8. Pressure as Function of Location in Arterial Tree Nichols & O’Rourke 2005

  9. Finger pressure Portapres NexFin Finometer

  10. Blood Pressure - Volume Clamp • Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat

  11. Blood Pressure - Volume Clamp • Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat • Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff

  12. Blood Pressure - Volume Clamp • Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat • Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff • Changes in diameter opposed by a fast pressure servo controller that changes finger cuff pressure

  13. Blood Pressure -Volume Clamp • Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat • Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff • Changes in diameter opposed by a fast pressure servo controller that changes finger cuff pressure • Expert system (Physiocal ) defines and maintains the correct diameter at which the finger artery is clamped Bogert LW, Van Lieshout JJ. Exp Physiol 2005;90(4):437-46

  14. Bogert LWJ et al. Anaesthesia, 2010

  15. Martina J et al. Revision

  16. Martina J et al. Revision

  17. Martina J et al. Revision

  18. Non-invasive pulse contour cardiac output - Outline • Continuous Finger Arterial Pressure • From Finger Pressure to Flow

  19. Windkessel model 1-3 The 3 element Windkessel model is used to determine the afterload (Zin) of the heart for every beat

  20. Windkessel model 2-3

  21. Windkessel model 3-3

  22. Nexfin CO-Trek Zin age gender height weight Z0 Cw stroke volume heart rate Rp cardiac output MAP Pressure

  23. 05/06 JJvL

  24. Harms MPM, Wesseling KH, Pott F, Jenstrup M, Van Goudoever J, Secher NH, Van Lieshout JJ. Clin Sci 1999 Jellema WT, Wesseling KH, Groeneveld AB, Stoutenbeek CP, Thijs LG, Van Lieshout JJ. Anesthesiology 1999

  25. Nissen P, Van Lieshout JJ, Novovic S, Bundgaard-Nielsen M, Secher NH. Liver Transplantation 2009

  26. Bogert LW, Wesseling KH, Schraa O, Van Lieshout EJ, De Mol BA, Van GJ, Westerhof BE, Van Lieshout JJ. Anaesthesia 2010

  27. Non-invasive pulse contour cardiac output - Outline • Continuous Finger Arterial Pressure • From Finger Pressure to Flow

  28. Perspective Continuous Cardiac Output Tissue Perfusion & Oxygenation

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