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Non Invasive Hemodynamic Monitoring
A Breakthrough Concept:PhysioFlowTM
Copyright : Manatec Biomedical, June 2005
Agenda
• Why Should I Measure Cardiac Output?• How Can I Measure Cardiac Output?• What is Impedance Cardiography?• Why PhysioFlow?• What are the benefits of PhysioFlow ?
Why Should I Measure Cardiac
Output?
1) Assess SHOCKED patients
2) Manage fluid and drug administration (plus weaning patients off ventilators)
3) Monitor unstable patients
Intensive Care
Physicians
1) Diagnose and follow up of Heart Failure and Hypertensive patients
2) Better manage of Bi-Ventricular PM patients
3) Improve sensitivity of CAD and dyspnoea diagnosis under exercise test
Cardiologists and
Internists
1) Physiology (extreme conditions, military)
2) Pharmacology (toxicology)
3) Sports medicine
Advanced Applications
and Research
How Can I Measure Cardiac Output?
INVASIVE
1) “Direct” Fick Method
2) Dye Dilution
3) Thermodilution (PA Catheter)
SEMI INVASIVE
1) Pulse Contour Analysis (PICCO)
2) Trans-Esophageal Doppler
1) “Indirect” Fick
2) Impedance Cardiography
NON INVASIVE
What is Impedance Cardiography? Emission of a low magnitude-high frequency electrical
signal though the thorax Measurement of the impedance modulations generated
by the cardiac blood flow Analysis of the pulsatile waveform and computation of
SV
CO = HR (ECG) . SV (ICG)
What is the Current Standard of ICG?
1. Impedance baseline (Z0) Thoracic Fluid Content (TFC)
2. The pulsatile waveform represents the circulating fraction of the TFC, which is the stroke volume
Volumetric approach
Kubicek
2max
2
0
)/.(..
Z
dtdZVETLSV
Srameck
0
)/.(. max
Z
dtdZVETVEPTSV
Z0 is sensitive to measurement conditions unreliable
Advanced PhysioFlow ICG
Morphological approach
Reduced limitations thanks to the absence of Z0
Normal Patients Heart Failure Patients Hyperkinetic Patients
Use of differential analysis on systolic impedance waveforms
PhysioFlow is …Accurate with Reproducible Results
Good correlation and agreement with reference techniques
Excellent test-retest coef. of variations
Not operator dependent Highly sensitive in tracking hemodynamic changes
2.5 5.0 7.5 10.0 12.5
-3
-2
-1
0
1
2
3
+ 2SD
- 2SD
CO : average of the two methods(L/min)
CO
: D
iffe
ren
ce
bet
we
en t
he
two
met
ho
ds
(L/m
in)
Comprehensive PhysioFlow
Parameters A more thorough and powerful diagnosis of patients is achievable through a combination of measured and computed parameters
HR, SV, CO, CI, VET, EF, Contractility INDEX
SVR, SVRi, LCWi
UNDER VALIDATION :
Early Diastolic Function Ratio : Assessing left ventricular filling problems
Example of PhysioFlow Parameters at Work
Trending on ICU patients
Detecting CAD during exercise test
Specific Display Hemodynamic Cross
Hyperkinetic
Septic Shock
Congestive Heart Failure
Allergic Shock
Neurotonic Hypertension
Vascular Hypertension
LCWI
SVRI
LCWI: Left Cardiac Work Index & SVRI: Systemic Vascular Resistance Index
PhysioFlow is …Expertise and Innovation
French Patent 1993 / US Patent 1997 4 phases of development
1989-1995 Dr. Jean Bour’s private R&D 1995-1999 Manatec, a R&D Company 1999-2005 Industrial phase 2006-? Handheld technology, OEM, FDA
Key market player through innovation and partnerships
It is totally non-invasive It requires only 6 pre-gelled electrodes It has a user-friendly software
With powerful data analysis and export functions
PhysioFlow is …Safe and Easy to Use
PhysioFlow has …Reduced Dependencies
No need for a specific or clean environment None of the major limitations of standard ICG apply
(except open chest surgery) Only electrical or mechanical interferences from some
other devices may impair measurements (electrosurgical instruments, high frequency ventilation…)
PhysioFlow Provides …Mutual Benefits to Patients /
Physicians Low-cost disposable sensors vs. expensive catheters Quick operation
Minutes vs. several hours for Swan-Ganz catheter No preventive maintenance dependability
More revenues Saving the cost of invasive procedures Expanding clinical benefits to many more patients
Conclusion
PhysioFlow is …
1. Non-invasive safe and easy to use
2. Accurate with reproducible results data can be trusted
3. Useable in most clinical settings
4. Cost effective mutual benefits to patients / physicians
Live Demonstrations (Q&A)
« The sphygmo-manometer would not be welcomed by the overworked and underpaid general practitioner already loaded with thermometer and stethoscope » - Blake E.: Recent British Researches on Arterial Tension. Med Times Gaz. 1895; 23:29
Case Studies : exercise test on athlete
Linear increase of cardiac output until max workload (32 l/min at 22 Km/h).
Case Studies : exercise test on untrained patient
Normal percentage of SV increment but flat trend after quick inital response
Case Studies : exercise test on CAD patient
SV decrases at 120 watts after having increased normally
Case Studies : exercise test on HF patient
No increase in SV
Case Studies : Legs Up Maneuver on HF patient
SV decrases : fluid overload
Case Studies : Adjustment of BIV Pacemaker
SV is better in LV-only mode compared to BIV and RV modes
Case Studies : Managing Hypertensive Patients
• The hemodynamic cross helps diagnose and treat HTN patients
Case Studies : Emergency Room
Septic shock : Increased LCWi Cardiac shock : Increased SVRi Depressed SVRi Depressed LCWi
Case Studies : Controlling unstable ICU patients
CO drops dramatically after infusion of atropine and recovers after fluid administration
Case Studies : Legs-up Maneuver on ICU patient
Shocked patient : increase of SV with increased preload. Indication for fluid administration
Case Studies : Controlling unstable ICU patients
Initial positive response after fluid administration, butSV decrases again after 35 min : probable fluid overload