Venous Oxygenation SCV02

2. Flow Contractility CO = Cardiac Output dPmx = Left Ventricular Contractility CI = Cardiac Index GEF = Global ejection fraction PCCI = Pulse Contour Cardiac Index CFI = Cardiac Function Index AP = Arterial Blood Pressure CPI = Cardiac Power Index SVI = Stroke Volume Index HR = Heart Rate Preload Afterload GEDI = Global End Diastolic Volume SVRI = Systemic Vascular Resistance ITBI = Intra Thoracic Blood Volume Index MAP = Mean Arterial Pressure Volume Responsiveness Pulmonary Odema SVV = Stroke Volume Variation ELWI = Extra Vascular Lung Water PPV = Pulse Pressure Variation PVPI = Pulmonary Vascular Permeability

3. Top tips: Keep pocket reference Keep your approach simple as possible Know what parameters represent: Flow Preload Afterload Contractility Oxygenation Lung Volume Response Different methods:

4. 2 examples to initial assessment: PiCCO 3 step CI Preload Lung Local protocol: Preload/ELWI Contractility/Afterload Cardiac Index

8. Vasopressors: Stimulate vasoconstriction Inotropes: Stimulate the force of cardiac contraction Some drugs do only one, some do both. Some drugs do one or both depending on dose

9. 1. Oxygen Delivery/Consumption: ScvO2 (70-80%) = Mixed venous oxygenation Low = Poor oxygen delivery (e.g. poorer CO = greater extraction Solution: look at preload, afterload & contractility High = Poor oxygen consumption (e.g. less oxygen extraction) Solution: look at oxygen delivery Normal? = Poor DO2 & VO2 High DO2 & High VO2

10. 1. Oxygen Delivery/Consumption: DO2 � Oxygen Delivery (400-650 ml/min/m2) VO2 � Oxygen Consumption (125-175 ml/min/m2)

11. 2. Flow: CO = Cardiac Output (4.0 � 8.0 l/min) CI = Cardiac Index (3.0-5.0 l/min/m2) SVI � Stroke Volume Index (40-60 ml/m2) The amount of blood ejected in one beat indexed to BSA

12. 2. Flow: PCCO = Pulse Contour Cardiac Output Cardiac output determined continuously from the pulse contour analysis PCCI = Pulse Contour Cardiac Index (3.0 � 5.0) Cardiac output determined continuously from the pulse contour analysis indexed to BSA Other parameters include: ABP = Arterial Blood Pressure HR = Heart Rate

13. 3. Preload: GEDI = Global End Diastolic Index (4.0 � 8.0 l/min) An excellent indicator of preload. It is the filling volume of all four heart chambers indexed to BSA ITBI = Intra Thoracic Blood Volume Idx (850-1000ml/m2) An alternative indicator of preload. It is the filling volume of all four heart chambers and pulmonary blood volume indexed to BSA Good preload = good cardiac output

14. 4. Afterload: SVRI = Systemic Vascular Resistance Index (1700 � 2400 Dyn*s/*cm-5*m2) Increased by vasopressors, cardiogenic shock and centralisation Decreased by sepsis and anaphylaxis MAP = Mean Arterial Pressure

15. 5. Contractility: GEF = Global ejection Fraction (25 � 35%) Correlates well with echocardiogram CFI = Cardiac Function Index (4.5 � 6.5 l/min) This is good for trends. It tells you about the relationship between flow and preload CPI = Cardiac Power Index (0.5 � 0.7 W/min2) This is the fraction of preload volume pumped in one minute which is a parameter of global cardiac contractility. This makes it invaluable as an indicator of cardiogenic shock

16. 5. Contractility: dPmx = Left ventricular contractility (Trend only) This is about the left ventricle contractility and is useful for trends only. Increasing trend tells you of increased contractility. Reduced trend � the reverse

17. 6. Volume Responsiveness: SVV = Stroke Volume Variation (<10%) PPV = Pulse Pressure Variation (<10%) Remember that these measure volume over the respiratory cycle. They are only applicable to patients being ventilated (with decent tidal volumes) and a normal sinus rhythm, (free from artifact).

18. 7. Lung: ELWI = Extra Vascular Lung Water (3.0-7.0 ml/kg) Elevated may indicate too much volume, poor contractility or an afterload that is too high. High shows intracellular, interstitial or intra alveolar odema PVPI = Pulmonary Pressure Vascular Permeability Index (1.0 - 3.0) PVPI is used to compare to ELWI: ELWI Normal (3.0 � 7.0) + PVPI Normal (1.0-3.0) = Normal ELWI High (7.0+) + PVPI Normal (1.0-3.0) = Cardiogenic ELWI High (7.0+) + PVPI High (3.0+) = Sepsis