pulseCO - PulseCO SPV SV • Predicts SV ↑ in response to...

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PulseCO Monitoring System Charles E. Smith, MD, FRCPC Professor of Anesthesia MetroHealth Medical Center Case Western Reserve University Cleveland, Ohio
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Estimates of Preload Clinical: BP, HR, capillary refill, urine Postural changes CVP PAC Echo
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Marik: Anaesth Intensive Care 1993;21:405. Coriat: Anesth Analg 1994;78:46 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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Linton R: 1997, 1998, 2000 Pulse Contour Analysis 1. Transform BP waveform into volume – time waveform 2. Derive uncalibrated SV SV x HR = CO 3. Calibrate using Li indicator [LidCO], Swan Ganz, or known SV from ejection fraction (Echo) Assumptions: PPV induces cyclical changes in SV Changes in SV results in cyclical fluctuation of BP or SPV
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Unformatted text preview: PulseCO SPV + SV • Predicts SV ↑ in response to volume after cardiac surgery + in ICU [Reuter: BJA 2002; 88:124; Michard: Chest 2002; 121:2000] • Similar estimates of preload v. echo during hemorrhage [Preisman: BJA 2002; 88: 716] • Helpful in dx of hypovolemia after blast injury [Weiss: J Clin Anesth 1999; 11:132] Calibration Using EF • Obtain uncalibrated SV tracing from PulseCO monitor • Estimate EF from preop echo or baseline cardiac status [usual SV approx 0.7-1 ml/kg] • Enter calibration factor on monitor Calibration Using EF Example 1: uncalibrated SV reading 140 ml/beat; 70 kg pt with normal EF; calibration factor = 0.5 Example 2: uncalibrated SV reading 100 ml/beat; 70 kg pt with DCM; calibration factor = 0.3 Pitfalls with SPV + SV • Inaccurate if – AI – IABP • Problems if – pronounced peripheral arterial vasoconstriction – damped art line – Arrhythmias...
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