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Mastering Cardiovascular Support in ICU: Essential Concepts and Medications

Learn about basic cardiovascular physiology, indications for cardiovascular support, and medications used in ICU scenarios. Understand cardiac output, stroke volume, mean arterial pressure, and more to optimize patient care. Explore various types of shock and clinical signs to recognize and manage effectively.

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Mastering Cardiovascular Support in ICU: Essential Concepts and Medications

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  1. Cardiovascular Support in ICU Dr ben harris

  2. Objectives • Basic physiology (+small amount of biochemistry) • Indications for CVS support • Drugs used for CVS support

  3. Some basic physiology • Cardiac output = ? • Stroke volume x heart rate • Stroke volume? • Mean arterial pressure = ? • Cardiac output x systemic vascular resistance • Diastolic BP + (1/3 systolic BP – diastolic BP) • Oxygen Delivery • Cardiac output x oxygen content (1.34 x SaO2 x Hb)

  4. MAP Stroke volume Heart rate Systemic Vascular Resistance

  5. MAP and CO

  6. MAP and SVR β1 Inotropy / Chronotropy β2 Vasodilation ⍺1 Vasoconstriction

  7. Shock Hypovolaemic Cardiogenic Septic Anaphylactic Neurogenic

  8. Shock

  9. Clinical Signs of Shock • Confusion • Delirium • Tachycardia • Hypotension • ⬆ CRT • Tachypnoea • Cool / Clammy • Warm / sweaty • Oliguria • Metabolic acidosis

  10. Lactate

  11. Anaesthesia

  12. Anaesthesia

  13. CVS Support • Optimise circulating volume • Fluids • Blood products in massive haemorrhage • Optimise other physiology

  14. CVS Support • Non-catecholamines • Ephedrine • Metaraminol • Phenylephrine

  15. CVS Support • Catecholamines

  16. CVS Support • Catecholamines • Noradrenaline • Adrenaline • Dopamine / dobutamine

  17. CVS Support

  18. CVS Support • Vasopressin • Milrinone • Levosimendan

  19. Summary • MAP = CO x SVR • 5 types of shock • Peripheral vasopressors • Central Vasopressors • Noradrenaline  vasopressin  adrenaline

  20. References • Cardiovascular failure, inotropes and vasopressors. British Journal of Hospital Medicine, May 2012, Vol 73, No 5 • Basic Sciences, Update in Anaesthesia, December 2008, Vol 24, No 2 • Mean Arterial Pressure, http://www.cvphysiology.com/Blood%20Pressure/BP006

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