Hemodynamic Parameter

Modul Created By. IACA

Introduction
Adequate blood circulation is vital for maintenance of adequate tissue metabolism Shock is a life threatening condition in which blood circulation unable to transport oxygen adequately to meet tissue metabolic need
(International Consensus on Hemodynamic Monitoring in Shock 2006)

Hemodynamic What, what organ involved, what for?

What is hemodynamic? Hemodynamic is blood flow within the cardiovascular system, it reflex cardiovascular performance Dynamic state, have an autoregulatory mechanism Multiparameter

What organ involved?

Organ involved in hemodynamic are the heart, the vascular bed and the lung (Cournand dkk, 1943; Finch dkk, 1972; Shoemaker dkk,
1973)

Nerve system, hormonal system and metabolism What for? To maintain and integrate all organ within the body

Hemodynamic parameters Based on direct measurement

Parameter Heart Rate Central Venous Pressure Right Atrial Pressure (M) Right Ventricular Pressure (S/D/EDP) Pulmonary Arterial Pressure (S/D/M) Pulmonary Artery Oclusion Pressure/ Pulmonary Arterial Wedge Pressure (M) Left Ventricular End Diastolic Pressure (D) Systemic Arterial Blood Pressure (S/D/M) Capillary Arteriolar Blood Oxygen Saturation Abbrev HR CVP RAP RVP PAP PAOP/ PAWP LVEDP BP SpO2 Unit bpm mm Hg mm Hg mm Hg mm Hg mm Hg mm Hg mm Hg % Normal 60 80 48 48 15-30/0-5/2-6 15-30/1015/10-20 4 -12 4 12 100-140/6070/70-100 96-98

Based on calculation/derived value

Parameter
Cardiac Output Cardiac Index Pulmonary Vascular Resistant Pulmonary Vascular Resistant Index Right Ventricular Stroke Work Index Systemic Vascular Resistant Systemic Vascular Resistant Index

Calculation
CO=SV x HR CI=CO/BSA PVR=PAm-PAWm/CO x 80 PVRI=PVR x BSA RVSWI=SVI x (PAm-RAm) x 0,0136 SVR=MAP-RAm/CO x 80 SVRI=SVR/BSA

Unit
L/mnt L/mnt/m2 dyne/sec/cm-5 dyne/sec/cm5/m2 g.m/m2/beat dyne/sec/cm-5 dyne/sec/cm5/m2

Normal
48L 2,5 - 4 30 - 100 70 - 180 4-8 9001400 17002600

Left Ventricular Stroke Work Index Coronary Perfusion Pressure Stroke Volume Stroke Volume Index

LVSWI=SVI x (MAPPAWm) x 0,0136 CPP=Dart PAWm/LVEDP SV=CO/HR x 1000 =EDV-ESV SVI=SV/BSA

g.m/m2/beat mm Hg ml/beat ml/beat/m2

40 - 75 60 - 80 60 - 120 30 - 60

Mixed Vein Saturation Oxygen Content Oxygen Delivery

S?o2 Cao2=Hb x SaO2 x 1,36 Do2=CO x Cao2 x 10

% vol% ml/mnt

65 - 75 17 - 20 7501000

EDV & ESV value produced by echo

Hemodynamic monitoring technique

Right/pulmonary Left/systemic

SpO2 Artery CVP BP

Placement of SGC tip

SGC

Right placement of catheter tip

Pressure wave form encountered during SGC insertion

Hemodynamic parameters and its characteristics

Circulation Parameter HR CVP RAP RVP PAP PAOP/PAW LVEDP BP Indicator ? preload preload afterload afterload preload preload afterload Influencing factors inervation, hormonal, resistant, preload, contractility capacity, volume, resistant, HR capacity, volume, resistant, HR, contractility preload, contractility, resistant, HR CO, resistant resistant, HR preload, LH, PVR, HR, after load CO, resistant v v v v Left/ systemic v Right/ pulmonary v v v v v Source non invasive v invasive v v v v v v

Note: for continuous intermittent purpose echografi / doppler substitute invasive method

Circulation Parameter Indicator Influencing factors Left/ systemic Right/ pulmonary

Source non invasive

invasive

SpO2 CO CI PVR PVRI RVSWI SVR SVRI

saturasi arteriol pompa

diffusi gas, asam-basa, V/Q preload, kontraktilitas, HR, tahanan CO, luas permukaan tubuh

v v v v v v v v v v

v v v v v v v v

tahanan

metabolisme, ventilasi, organ PVR, luas permukaan tubuh

kontraktilitas tahanan

metabolisme, preload metabolisme, ventilasi, organ SVR, luas permukaan tubuh

Note: for continuous intermittent purpose echografi / doppler substitute invasive method

Circulation Parameter Indicator Influencing factors Left/ systemic Right/ pulmonary

Source non invasive invasive

LVSWI CPP SV SVI S?o2 Cao2 Do2

contractility perfusion volume

metabolism, preload SVR, preload, HR preload, contractility, resistance SV, BSA

v v v v v v v v v v v v

v v v v v

mixed vein O2 saturation kandungan supply

CO, O2 extraction, acid-base Hb, saturation, V/Q CO, Cao2

Note: for continuous intermittent purpose echografi / doppler substitute invasive method

Hemodynamic evaluation as a guidance to patient therapy will only useful if followed by appropriate therapy/intervention
BP Dx Rx VFP Dx Rx SV Dx Rx High vol>/<,SVR>,LHF,hyperdinamic, Low vol.>/<,SVR<,LHF,RHF,PH

Clinical application based on hemodynamic evaluation

diuret.,venodil,inotrop,art.dil.,analget.,sedation art.consctr.,inotrop,vol>,art.dil.,PAdil , block,vol.> High vol.>,SVR>,LHF diuret.,venodil.,inotro p,art.dil. High vol.> diuret., venodil. Low SVR>, LHF inotrop, art.dil. Low High Low SVR<,vol.<,RHF,PH art.constr.,vol.>,inotro p,PAdl. High SVR< art.cons Low vol.<, RHF,PH vol.>, inotrop,P Adil

hiperdynamic,SVR>,v vol.>,SVR<,LVF ol.< vol.>,art.dil.,analget.,s edation, block High Hyperdin amic analget., sedation, block Low SVR>>,v ol.< vol.>, art.dil. inotrop,vol.>,art.const r.,art.dil. High vol.>, SVR< art.constr Low LHF prn:inotro p,vol.,art. dil.

Thank You