Haemodynamic Monitoring

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. Optimisation of CO Monitoring – what is the point? The haemodynamic instability is identified. What can be done for the patient (sepsis example)? Aim? Optimisation of CO 1. Step: Volume Management Recommendation of the SSC How can you optimise CO? 3

4. Optimisation of CO Monitoring – what is the point? Optimisation of CO Preload Contractility Afterload Chronotropy Frank-Starling mechanism 4

5. Optimisation of CO Preload, CO and Frank-Starling Mechanism SV V SV SV V Normal contractility SV V volume responsive target area volume overloaded Preload 5

6. SV V SV V Optimisation of CO Preload, CO and Frank-Starling Mechanism SV Normal contractility Poor contractility volume responsive target area volume overloaded Preload 6

7. SV V SV V Optimisation of CO Preload, CO and Frank-Starling Mechanism SV High contractility Normal Contractility Poor contractility volume responsive target area volume overloaded Preload 7

8. Optimisation of CO Preload, CO and Frank-Starling Mechanism SV V SV SV V SV V volume responsive target area volume overloaded Preload In order to optimise the CO you must know what the preload is! 8

9. Optimisation of CO Summary and Key Points • The goal of fluid management is the optimisation of cardiac output • An increase in preload leads to an increase in cardiac output, within certain limits. This is explained by the Frank-Starling mechanism. • The measurement of cardiac output does not show where the patient’s heart is located on the Frank-Starling curve. • For optimisation of the CO a valid preload measurement is indispensable. 9