hemodynamic monitoring interpretation · hypovolemia $ $ $ $ interpretation 20 • = pwp = paop %...

Interpretation

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Hemodynamic Monitoring Interpretation

2 Interpretation

•  Is easy!

•  Don’t work to make it hard!!!

3 Interpretation

hemo =

dynamic =

hemodynamic =

Interpretation

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4 Interpretation

•  Circulation occurs because of blood pressure

! Hemodynamics =

5 Interpretation

•  Without enough BP, tissues will not receive needed oxygen & nutrients

•  However, high BP strains the heart & will eventually cause heart failure

6 Interpretation

•  If BP " # •  If BP $#

•  Arterial BP can change w/o affecting venous BP so must measure all BP’s

Interpretation

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7 Interpretation

•  Heart •  Pump that creates pressure gradient •  Changes in the heart itself will directly

affect BP:

"HR or strength of contraction #

$ HR or strength of contraction #

8 Interpretation

•  Blood •  Amount of fluid in circulatory system

affects BP:

"blood volume #

$ blood volume #

9 Interpretation

•  Vessels •  Tone of the blood vessels affect BP:

vasoconstriction #

vasodilation #

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10 Interpretation

•  We can manipulate all 3 factors that control BP •  HR, contractility (epinephrine, Dopamine) •  Blood volume (diuretics) •  Vessel tone (epinephrine, Nitroprusside,

Dopamine) •  Changes in hemodynamic

measurements will reveal which of the 3 has been altered

11 Interpretation

•  “Rule of 4’s” •  Heart has 4 chambers •  Each chamber serves 1 of the 4 circulatory

branches:

•  LV -

•  RA -

•  RV -

•  LA -

12 Interpretation

•  Each chamber & connecting artery or venous system has its own BP - 4 pressures

•  LV - systemic arteries -

•  RA - systemic veins -

•  RV - pulmonary arteries -

•  LA - pulmonary veins -

•  Hemodynamics measures each of these pressures

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13 Interpretation

Enter capillaries In capillaries Leave capillaries

14 Interpretation

1.  Must be the same from both ventricles 2.  Normally % 3.  If not:

HR 100/min RVSV 70 ml LVSV 69.9 ml

= 7.0 lpm = 6.99 lpm

x 60 min = 420.0 liters x 60 min = 419.4 liters

.6 L. = 600 ml

Where is that 600 ml?

HR 100/min RVSV 70 ml LVSV 69.9 ml

= 7.0 lpm = 6.99 lpm

x 60 min = 420.0 liters x 60 min = 419.4 liters .6 L. = 600 ml

15 Interpretation

•  CVP = RAP = RVEDP = RV preload •  Measures pressure in the systemic

venous system •  Much lower than mean ABP •  Since most of blood is in the venous

system, changes in the CVP reflect changes in vascular volume . . . .

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16 Interpretation

CVP used to monitor vascular fluid levels & right heart function

•  Treat when - •  Transducer at level of RA

17 Interpretation

Condition CVP PAP PCWP QT

RV Failure " (N) $ (N) $ (N) $

Hypervolemia " " " "

Hypovolemia $ $ $ $

18 Interpretation

•  Measures blood moving through the pulmonary arteries into the lungs

Increases in PAP occur in lung disease/" PVR

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19 Interpretation


Lung Problems COPD Pulmonary emboli ARDS (Pulm. edema) Pneumonia

" " (N) $ (N) $


Hypovolemia $ $ $ $

20 Interpretation

•  = PWP = PAOP % LAP % LVEDP % LV preload

•  When BTFDC “wedged” - no longer measures forward flow of blood

•  Measures back pressure from pulm. veins which are in direct communication with left heart

21 Interpretation

PCWP monitors left heart (LV & mitral valve)

!  Treat when -

Interpretation

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22 Interpretation

$ $ $ $ Hypovolemia

" " " " Hypervolemia

(N) $

>12 mmHg

>18 mmHg

" " " Left Heart Problems LV failure Mitral valve stenosis Cardiogenic pulm. edema High PEEP

QT PCWP PAP CVP Condition

23 Interpretation


Right heart " (N) $ (N) $ (N) $

Lung Problems " " (N) $ (N) $

Left heart " " " $


Hypovolemia $ $ $ $

24 Interpretation

" PAP + normal PCWP =

" PAP + " PCWP =

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25 Interpretation

PAd - PCWP:

26 Interpretation

PCWP cannot be >

27 Interpretation

•  Preload = •  Afterload = •  BTFDC tip should lie in a Zone III artery •  QT $ # O2 extraction " # PvO2, SvO2 $ # C(a-v)O2 "

•  SvO2 is best indicator of tissue oxygenation

. _ _

_

_

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28 Interpretation

56 yof, post-op chole, MVS

1500 hrs 1700 hrs 1900 hrs BP (mmHg) 128/100 126/90 100/60 CVP (cmH2O) 10 6 4 HR 88 96 126

29 Interpretation

•  64 yom PAP 40/26 mmHg PCWP 18 mmHg CVP 10 cmH2O QT 3.4 lpm

.

30 Interpretation

•  70 kg. male PAP 53/34 mmHg PCWP 28 mmHg CVP 10.6 cmH2O C(a-v)O2 2.7 vol%

_

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31 Interpretation

•  ICU patient PAP 26/8 mmHg PA mean 15 mmHg PCWP 28 mmHg QT 6.0 lpm

.

32 Interpretation

•  68 yof PAP 52/30 mmHg PCWP 10 mmHg CVP 12 mmHg QT 3.9 lpm

.

33 Interpretation

•  50 kg. patient PAP 43/21 mmHg PCWP 3 mmHg CVP 12 cmH2O QT 3.9 lpm C(a-v)O2 7.2 vol%

. _

Interpretation

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34 Interpretation

Which of the following disorders is known to cause the PCWP to become elevated?

a. ARDS b. LVF c. RVF d. hypervolemia e. increased PVR

35 Interpretation

Data of 70 kg. patient in ICU: Which of the following drugs

would the RCP be least likely PAP 53/39 mmHg to recommend? PCWP 32 mmHg QT 3.4 lpm a. Dopamine C(a-v)O2 7.3 vol% b. morphine sulfate Temp. 36.8° c. oxygen

d. propanolol (Inderol) e. furosemide (Lasix)

. _

36 Interpretation

Data of 70 kg. patient in ICU: Which of the following is most

likely to be responsible for this PAP 60/38 mmHg patient’s elevated PCWP? PCWP 26 mmHg QT 11.7 lpm a. hypervolemia C(a-v)O2 1.9 vol% b. hypovolemia VO2 285 ml/min c. LVF

d. ARDS e. RVF

. _

.

Interpretation

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37 Interpretation

Data of 70 kg. patient in ICU: Which of the following

assessments regarding this PAP 22/6 mmHg patient is true? PCWP 2 mmHg C(a-v)O2 7.9 vol% a. Patient is hypovolemic. Temp. 37° b. LVF exists.

c. The QT is decreased. d. Pulm. edema is inevitable.

_

.

38 Interpretation

RCP is monitoring a patient in ICU: Which of the following is the

most appropriate assessment? PAP 23/7 mmHg PCWP 26 mmHg a. Data is in error PA mean 16 mmHg b. LV dysfunction exists QT 10.6 lpm c. PVR is increased

d. Patient is hypovolemic e. Normal study

39 Interpretation

Data of 50 kg. patient in ICU: Which of the following is(are)

true statements? CVP 10 mmHg PAP 43/21 mmHg a. LVF exists. PCWP 2 mmHg b. Patient is hypovolemic. QT 2.9 lpm c. CV reserves are excellent. C(a-v)O2 8.2 vol% d. PVR is increased. VO2 280 ml/min

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40 Interpretation

28 yof, 4 days post- Fx femur: Which of the following is most

likely responsible? RR 40/min PAP 44/27 mmHg a. LVF exists. PCWP 6 mmHg b. Patient is hypervolemic. QT 5 lpm c. Pulm. emboli are present. BP 85/50 mmHg d. PVR is increased.

41 Interpretation


mechanisms is(are) responsible PCWP 36 mmHg for the low QT? QT 3.1 lpm C(a-v)O2 7.9 vol% a. RVF VO2 245 ml/min b. LVF

c. hypovolemia d. increased PVR e. ARDS

42 Interpretation


mechanisms is(are) responsible PCWP 3 mmHg for the low QT? QT 3.1 lpm C(a-v)O2 7.9 vol% a. RVF VO2 245 ml/min b. LVF

c. hypovolemia d. ARDS

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hemodynamic monitoring interpretation · hypovolemia $ $ $ $ interpretation 20 • = pwp = paop %...

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