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Hemodynamic Measurements: Pulmonary Catheter & Calculated Values

Learn about hemodynamic measurements obtained directly through the pulmonary catheter and calculated values derived from them. Understand stroke volume, stroke volume index, cardiac index, right ventricular stroke work index, left ventricular stroke work index, pulmonary vascular resistance, and systemic vascular resistance.

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Hemodynamic Measurements: Pulmonary Catheter & Calculated Values

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  1. CHAPTER 15 Hemodynamic Measurements

  2. HEMODYNAMIC MEASURMENTS DIRECTLY OBTAINED BY MEANS OF THE PULMONARY CATHETER

  3. Insertion of Pulmonary Catheter • Fig. 15-1. Insertion of Pulmonary Catheter.

  4. Hemodynamic Values Directly Obtained by Pulmonary Artery Catheter Table 5-1

  5. HEMODYNAMIC VALUES COMPUTED FROM DIRECT MEASURMENTS

  6. Computed Hemodynamic Values Table 15-1

  7. Stroke Volume (SV) • SV is the volume of blood ejected by the ventricles with each contraction • Preload, afterload, and myocardial contractility are major determinants of SV

  8. Stroke Volume (SV) • SV is derived by dividing the cardiac output (CO) by the heart rate

  9. Stroke Volume (SV) • For example, if an individual has a cardiac output of 4.5 L/min (4500 mL/min) and a heart rate of 75 beats/min, the stroke volume would be calculated as follows:

  10. Factors Increasing and Decreasing SV, SVI, CO, CI, RVSWI, and LVSWI Table 15-3

  11. Factors Increasing and Decreasing SV, SVI, CO, CI, RVSWI, and LVSWI Table 15-3

  12. Stroke Volume Index (SVI) • SVI is derived by dividing the SV by the body surface area (BSA)

  13. Stroke Volume (SVI) • For example, if a patient has a stroke volume of 60 mL and a body surface area of 2 m2, the SVI would be determined as follows:

  14. Stroke Volume (SVI) • Assuming the heart rate remains the same, as the SVI increases or decreases, the CI also increases or decreases. • The SVI reflects: • Contractility of the heart • Overall blood volume status • Amount of venous return • See Table 15-3

  15. Cardiac Index (CI) • CI is calculated by dividing the CO by the body’s surface area (BSA)

  16. Cardiac Index (CI) • For example, if a patient has a cardiac output of 5 L/min and a body surface area of 2 m2, the cardiac index is computed as follows: • See Table 15-3 for a list of factors that increase and decrease the cardiac index

  17. Right Ventricular Stroke Work Index (RVSWI) • Measures amount of work required by right ventricle to pump blood • Reflects the contractility of right ventricle • Increases in afterload causes RVSWI to increase, until plateau is reached

  18. Right Ventricular Stroke Work Index (RVSWI) • Derived from the following formula:

  19. Right Ventricular Stroke Work Index (RVSWI) • For example, if a patient has an SVI of 35 mL, a PA of 20 mm Hg, and a CVP of 5 mm Hg, the patient’s RVSWI is calculated as follows: (next slide)

  20. Right Ventricular Stroke Work Index (RVSWI)

  21. Left Ventricular Stroke Work Index (LVSWI) • Measures amount of work required by left ventricle to pump blood • Reflects contractility of the left ventricle • Increases in afterload causes the LVSWI to increase, until plateau is reached

  22. Right Ventricular Stroke Work Index (RVSWI) • The LVSWI is derived from the following formula:

  23. Left Ventricular Stroke Work Index (LVSWI) • For example, if a patient has an SVI of 30 mL, an MAP of 100 mm Hg, and a PCWP of 5 mm Hg, then:

  24. Vascular Resistance • As blood flows through the pulmonary and then the systemic vascular system there is resistance to flow. • Pulmonary system is a low resistance system • Systemic vascular system is a high resistance system

  25. Pulmonary Vascular Resistance (PVR) • PVR measurement reflects afterload of right ventricle. • It is calculated by the following formula:

  26. Pulmonary Vascular Resistance (PVR) • For example, to determine the PVR of a patient who has a PA of 15 mm Hg, a PCWP of 5 L/min: • (Next slide)

  27. Pulmonary Vascular Resistance (PVR)

  28. Factors that Increase Pulmonary Vascular Resistance (PVR) Table 15-4

  29. Factors that Increase Pulmonary Vascular Resistance (PVR) Table 15-4

  30. Factors that Decrease Pulmonary Vascular Resistance Table 15-5

  31. Systemic or Peripheral Vascular Resistance (SVR) • SVR measurement reflect the afterload of the left ventricle. It is calculated by the following formula:

  32. Systemic or Peripheral Vascular Resistance (SVR) • If a patient has an MAP of 80 mm Hg, a CVP of 5 mm Hg, and a CO of 5 L/min:

  33. Factors that Increase and Decrease Systemic Vascular Resistance (SVR) Table 15-6

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