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Cardiac outputmonitoring

Inese Kutovaja09/07/2008ICU RPH

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CARDIAC OUTPUTMONITORING

Invasive

PA catheter

Non-invasive

TOE, EchocardiographyOesophageal doppler

AortovelographyTransthoracic impedance

Arterial pulse contour analysis (PiCC O) Arterial pulse power analysis (LiDC O)

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PULMONARY ARTHERYCATHETER

Also known as:PA Catheter

Swan-Ganz Catheter Swan

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PURPOSE

PA catheter is designed to measure:intra-cardiac pressurespulmonary artery pressurescardiac outputoxygen saturation

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CANDIDATES MI with complicationsCHFPulmonary H TN

Respiratory failure Shock Sepsis Trauma

Hemodynamic instability

High risk cardiac surgeryPeripheral vascular surgery

Aortic surgery Neuro surgery

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CONTRAINDICATIONS

Tricuspid or pulmonary valve mechanicalprosthesisRight heart mass (thrombus and/or tumor )

Tricuspid or pulmonary valveendocarditis

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F LOAT PA CATHETER

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DISTANCE MARKINGS

S iteS ubclavian veinInternal Jugular

Femoral vein

Distance to PA35-50 cm40-55 cm

60 cm

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PA CATHETER CROSSSECTION

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PROXIMAL PORT IN RIGHTATRIUM

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CVP WAVE F ORM

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RIGHT VENTRICULARPORT (orange)

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DISTAL PORT (yellow)

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PAP WAVE F ORM

S imilar in appearance to arterialwaveform

Waves Systolic pressure

Dicrotic notch End diastolic pressure

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PAP WAVE F ORM

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PAP

Low Volume depletion

Drugs

HighPulmonary H TNPulmonary Embolus

Mitral stenosisLV failure

Septal wall defects

Normal valuesPA systolic pressure = 20-30 mm HgPA diastolic pressure = 8-12 mm Hg

About 25/10

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Pulmonary Artery Occlusive

Pressure (PAOP)

Also known as:

Pulmonary capillary wedge pressurePC WPP WPPA W

Wedge pressure Wedge

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Pulmonary Artery

Occlusive Pressure (PAOP) Normal mean value

8-12 mm HgLow (< 8 mm Hg )hypovolemia

High (>12 mm Hg )hypervolemia

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Thermistor / Connector

Thermistor

Measures temperature of bloodThermistor connector Connects swan to display monitor

Sends temperature info to monitor

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PA Catheter Complications

Infection Air emboli

ThrombosisPA infarction

PA rupture Balloon rupture

ThrombocytopeniaCatheter knotting

Ventricular DysrhythmiasHemothoraxPneumothoraxCardiac Tamponade

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CO MEASUREMENT USING

PA CATHETER

1)Fick method/principle

2) Indicator dilution technique

-dye dilution

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CO MEASUREMENT USINGPA CATHETER

- thermo dilution

S teward-Hamilton equation:

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Temperature-versus-time

curve

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NON INVASIVE CARDIACOUTPUT MONITORING

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OESOPHAGEAL DOPPLERMeasurement of blood flow velocity in the

descending aorta at the tip of the flexible probe.

4 MHz continuous or 5 MHz pulsed wave

CO (cardiac output )SV (stroke volume )

FTc (corrected f low time )P V (peak velocity )MD (minute distance ) HR (heart rate )

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OESOPHAGEAL DOPPLER

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OESOPHAGEAL DOPPLER

Principle of strokevolume calculationfrom aortic

velocity ( V Ao ) measurements. The area under the maximum

aortic velocityenvelope ( VTI) represents thestroke distance

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OESOPHAGEAL DOPPLER

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OESOPHAGEAL DOPPLER

Normovolaemia : wide bases , tall peaks

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OESOPHAGEAL DOPPLER

Hypovolaemia: narrow waveform , low correctedflow time ,Good peak velocity , decreased C O, SV,

borderline HR

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LiDCOLithium Indicator DilutionContinuous , real-time cardiovascular monitoring

Minimally invasive Arterial pulse power analysis

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Advantages of the LiDCO

SAFE-Central/peripheral venous and arterial catheters-injectate is an isotonic (150 m M) solution of

lithium chloride-0.15 -0.30 mmol for an average adult-patient weight (> 40kg ) and absence of renal

dysfunction or dialysisACCURATES IMPL E TO USE

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LiDCO

Cardiac Output = ( Li th ium D ose x 60)/(A rea x (1 -P CV))

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LiDCO

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LiDCO

-cardiac shunt

-AF

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PiCCOPulse contour analysis with intermittent

thermodilution measurement.

Enables continuous hemodynamic monitoring using:- femoral or axillary artery catheter -central venous catheter

Adult or pediatric patients who have or may developpulmonary edema or ARD S are likely candidates

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PiCCOvia continuous pulse contour analysis

Continuous pulse contour cardiac analysis(PCC O)

Arterial blood pressure (AP )Heart rate (HR )

Stroke volume ( SV) Stroke volume variation ( SVV) Systemic vascular resistance ( SV R)

Index of left ventricular contractility

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PiCCOvia intermittent transpulmonary thermodilution

Transpulmonary cardiac output (C. O.)Intrathoracic blood volume (I TBV)

Extravascular lung water ( EVLW) (Not Available inUnited States)Cardiac function index (CFI )

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PiCCO

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PiCCO

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