Hemodynamic monitoring in ICU web

Hemodynamic monitoring in ICU web - DM SEMINAR Invasive and...

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DM SEMINAR Invasive and non-invasive hemodynamic monitoring in the ICU Dr. SACHIN KUMAR 14.03.08
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Not everything that counts can be counted; And not everything that can be counted counts ALBERT EINSTEIN
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INTRODUCTION Hemodynamic monitoring - cornerstone in the management of the critically ill patient Identify impending cardiovascular insufficiency, its probable cause, and response to therapy Despite the many options available, utility of most hemodynamic monitoring is unproven. Intensive Care Med. 2008 Jan 5 .e pub
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Why hemodynamic monitoring? Physicians have developed a psychological dependence on feedback from continuous hemodynamic monitoring tools, independent of their utility Effectiveness of hemodynamic monitoring to improve outcome limited to specific patient groups and disease processes for which proven effective treatments exist Chest. 2007 ; 132(6):2020-9
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Rationale for Hemodynamic Monitoring Monitoring device will improve patient- centered outcomes when coupled to a treatment which, itself, improves outcome Time - crucial for early diagnosis of hemodynamic catastrophe - earlier therapy improves outcome in this situation . N Engl J Med 2001; 345:1368–1377
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Hemodynamic Monitoring Non Invasive Clinical variables BP ECG Echocardiography Esophageal doppler Gastric tonometry Invasive CVP PAOP Pulse waveform analysis Microcirculation SvO2/ ScvO2 DO2/VO2 Lactate levels
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CLINICAL PARAMETERS Blood pressure Heart rate and rhythm Rate of capillary refill of skin after blanching Urine output Mental status Effects of body position on blood pressure Level 1 D Intensive Care Med. 2007; 33:575–590 International Consensus Conference
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BLOOD PRESSURE Arterial pressure is commonly measured non invasively on an intermittent basis using a sphygmomanometer Normal blood pressure hemodynamic stability Hypotension (MAP < 65 mmHg) is always pathological No RCTs evaluating the impact of arterial pressure monitoring on outcomes when used in ICU or operating room Intensive Care Med. 2008 Jan 5 .e pub Critical Care 2005, 9: 566-572
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Measuring Blood Pressure • Mercury sphygmomanometer • Oscillatory method • Measures mean pressure - systolic and diastolic pressures are calculated, prone to error • Infra sound / Ultrasonic technology • Very low frequency components of Krotokoff sounds below 50 Hz- very operator dependent • Impedance plethysmography • Monitors change in electrical impedance with local pulsatile arterial distension occurring with each cardiac cycle • Arterial tonometry • Applied pressure measured by sensors and arterial waveform constructed using an algorithm- not shown good correlation with directly measured pressure Crit Care Clin.2007; 23 :383–400
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INVASIVE BP Guidelines recommend invasive blood pressure measurement in refractory shock - Level 1D • Intra-arterial pressure measurement more precise • Continuous monitoring of pressure
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Hemodynamic monitoring in ICU web - DM SEMINAR Invasive and...

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