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