invasiveMonitoring09 - Invasive Monitoring Charles E....

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Invasive Monitoring Charles E. Smith, MD MetroHealth Medical Center Case Western Reserve University Cleveland, Ohio Email: csmith@metrohealth.org
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Siegel JH et al: Trauma: Emergency Surgery + Critical Care, 1987:2
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Definition of Monitoring Continuous or repeated observation + vigilance in order to maintain homeostasis ASA Standards: I. Qualified personnel II. Oxygenation: SaO2, FiO2 III. Ventilation: ETCO2, stethoscope, disconnect alarm IV. Circulation: BP, pulse, ECG Other monitors: T, Paw, Vt, ABG
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Objectives Arterial line Systolic pressure variation Central venous pressure Pulmonary artery catheterization Cardiac output Mixed venous oxygen
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Arterial Line Indications: Rapid moment to moment BP changes Frequent blood sampling Circulatory therapies: bypass, IABP, vasoactive drugs, deliberate hypotension Failure of indirect BP: burns, morbid obesity Pulse contour analysis: SPV, SV
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Radial Artery Cannulation Technically easy Good collateral circulation of hand Complications uncommon except: vasospastic disease prolonged shock high-dose vasopressors prolonged cannulation
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Alternative Sites Brachial: Use longer catheter to traverse elbow joint Postop keep arm extended Collateral circulation not as good as hand Femoral: Use guide-wire technique Puncture femoral artery below inguinal ligament (easier to compress, if required)
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Marik: Anaesth Intensive Care 1993;21:405. Coriat: Anesth Analg 1 Systolic Pressure Variation Difference between maximal + minimal values of systolic BP during PPV 2200 down: ~ 5 mm Hg due to venous return SPV > 15 mm Hg, or down > 15 mm Hg: highly predictive of hypovolemia
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Gardner, in Critical Care, 3rd ed. Civetta. 1997, p 851
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invasiveMonitoring09 - Invasive Monitoring Charles E....

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