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European Society for Computing and Technologyin Anesthesia and Intensive Care 2010
Non-invasive pulse contour cardiac output by Nexfin technology
Johannes J. van Lieshout, Wilbert A. Wesselink, Berend E. WesterhofSpecial Medical Care, Dpt Internal Medicine
Laboratory for Clinical Cardiovascular Physiology, Center for Heart Failure Research
Academic Medical Center Amsterdam
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Casus
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Casus
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• Continuous Finger Arterial Pressure
• From Finger Pressure to Flow
Non-invasive pulse contour cardiac output - Outline
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Clinical standard
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9/00 JJvL05/06 JJvL
late 1970s: Non-Invasive Blood pressure Device (NIBD)
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9/00 JJvL05/06 JJvL
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Pressure as Function of Location in Arterial Tree
Nichols & O’Rourke 2005
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Finger pressure
Portapres
Finometer
NexFin
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Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat
Blood Pressure - Volume Clamp
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Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat
Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff
Blood Pressure - Volume Clamp
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Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat
Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff
Changes in diameter opposed by a fast pressure servo controller that changes finger cuff pressure
Blood Pressure - Volume Clamp
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Bogert LW, Van Lieshout JJ. Exp Physiol 2005;90(4):437-46
Blood Pressure - Volume Clamp
Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat
Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff
Changes in diameter opposed by a fast pressure servo controller that changes finger cuff pressure
Expert system (Physiocal ) defines and maintains the correct diameter at which the finger artery is clamped
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Bogert LWJ et al. Anaesthesia, 2010
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Martina J et al. Revision
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Martina J et al. Revision
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Martina J et al. Revision
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• Continuous Finger Arterial Pressure
• From Finger Pressure to Flow
Non-invasive pulse contour cardiac output - Outline
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Windkessel model 1-3
The 3 element Windkessel model is used to determine the afterload (Zin) of the heart for every beat
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Windkessel model 2-3
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Windkessel model 3-3
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Nexfin CO-Trek
age
gender
height
weight
Z0
Cw
stroke volume
cardiac output
heart rate
RpPressure
MAP
Zin
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05/06 JJvL
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Harms MPM, Wesseling KH, Pott F, Jenstrup M, Van Goudoever J, Secher NH, Van Lieshout JJ. Clin Sci 1999 Jellema WT, Wesseling KH, Groeneveld AB, Stoutenbeek CP, Thijs LG, Van Lieshout JJ. Anesthesiology 1999
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Nissen P, Van Lieshout JJ, Novovic S, Bundgaard-Nielsen M, Secher NH. Liver Transplantation 2009
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Bogert LW, Wesseling KH, Schraa O, Van Lieshout EJ, De Mol BA, Van GJ, Westerhof BE, Van Lieshout JJ. Anaesthesia 2010
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• Continuous Finger Arterial Pressure
• From Finger Pressure to Flow
Non-invasive pulse contour cardiac output - Outline
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Continuous Cardiac Output
Tissue Perfusion & Oxygenation
Perspective
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