Hemodynamic Monitoring

01.02.2009

Englisch

9783837410631

UNI-MED

UNI-MED Science

Nein

Joachim Boldt

160

1

Gebundene Ausgabe

Contents 1. Monitoring of Cardiac Preload 16 1.1. Static Preload Parameters 17 1.2. Echocardiography 21 1.3. Dynamic Preload Parameters 22 1.4. Fluid Responsiveness in Patients with Reduced Left Ventricular Function 23 1.5. Fluid Responsiveness in Spontaneously Breathing Patients 23 1.6. Future Preload Parameters 24 1.7. Conclusions 25 1.8. References 29 2. Monitoring of Cardiac Afterload 34 2.1. Significance of Afterload for Cardiac Function 34 2.2. Methods of Measuring Cardiac Afterload 35 2.2.1. Pulmonary Artery Catheter (PAC) 36 2.2.2. Echocardiography 37 2.2.3. PiCCO® (Pulscontour Continuous Cardiac Output) 39 2.2.4. Impedance Cardiography (ICG) 41 2.3. Model of Applied Afterload Monitoring in Left Ventricular Failure 43 2.4. References 45 3. Monitoring of Right Ventricular Hemodynamics 48 3.1. Why Look More Closely into Right Ventricular Hemodynamics? 48 3.2. Assessing Preload Conditions 49 3.3. Assessing Right Ventricular Hemodynamics by Thermodilution 50 3.4. Problems in Measuring Right Ventricular Hemodynamics by Thermodilution 50 3.5. New Developments 52 3.6. Cost Considerations 52 3.7. Monitoring Right Ventricular Hemodynamics in a Clinical Setting 52 3.8. Monitoring of Right Ventricular Hemodynamics and Outcome 54 3.9. Conclusions 54 3.10. References 55 4. Less Invasive Monitoring of Cardiac Output 60 4.1. Historical and Physiological Background 60 4.2. Tracking Cardiac Output from a Peripheral Artery 61 4.3. Conclusions 66 4.4. References 66 5. Non-Invasive Determination of Cardiac Output 70 5.1. Esophageal Doppler 70 5.2. Bioimpedance 72 5.3. Arterial Waveform Analysis 74 5.4. Pulmonary Gas Exchange (Fick Principle) 74 5.5. Conclusion 75 5.6. References 77 6. Venous Oximetry: Monitoring of SvO2 and ScvO2 80 6.1. Metabolic Autoregulation of the Cell 80 6.2. Oxygen Supply and Demand 80 6.3. Principles of Venous Oximetry 81 6.3.1. Technical Aspects 81 6.3.2. Physiology of Venous Saturation Monitoring 82 6.3.3. S(c)vO2 in the Context of Validity and History of Hemodynamic Monitoring 82 6.3.4. The Carbon Footprint of Cellular Respiration 83 6.3.5. Levels and Levers of Pathophysiological Adaptation 84 6.3.6. Indications for Venous Oximetry 85 6.3.7. SvO2 and ScvO2 are not Identical, but Functionally Equivalent 85 6.3.8. Significance of Venous Saturation Monitoring 86 6.3.9. A Safety Corridor of ScvO2-Values 87 6.4. Critical Evaluation of the Technique 88 6.4.1. Importance of a Synoptic Monitoring Strategy of O2 in Dynamic Equilibrium 88 6.5. Conclusion and Recommendations 88 6.6. References 89 7. Pressure Monitoring Using the Pulmonary Artery Catheter 92 7.1. Introduction and Historical Perspective 92 7.2. PAC Pressure Measurement Principles 93 7.3. Measuring Ppao 97 7.4. Estimating Pulmonary Capillary Pressure 97 7.5. Airway Pressure and Ppao 98 7.6. Pleural Pressure, PEEP and Ppao 99 7.7. Conclusions 101 7.8. References 102 8. Echocardiography as a Diagnostic and Monitoring Tool 106 8.1. Basic Physical Principles of Ultrasound 107 8.2. Systolic Function and Contractility 111 8.3. Diastolic Dysfunction 114 8.4. Preload and Evaluation of Filling Pressures 118 8.5. Preload and Fluid Responsiveness 119 8.6. Afterload 119 8.7. Accreditation and Certification in Echocardiography 120 8.8. Conclusions 120 8.9. References 120 9. Monitoring of Microcirculation 126 9.1. Physiology of Microcirculation 126 9.2. Microcirculation in Sepsis and Septic Shock 127 9.3. Intravital Microscopy 129 9.4. Orthogonal Polarization Spectral (OPS) Imaging and Sidestream Darkfield (SDF) Imaging 130 9.5. Laser Doppler Flowmetry 132 9.6. References 133 10. Monitoring of Extravascular Lung Water 136 10.1. Principles of Monitoring EVLW 136 10.2. Advantages in Monitoring Extravascular Lung Water 138 10.3. Disadvantages in Monitoring Extravascular Lung Water 139 10.4. Conclusion 140 10.5. References 140 11. Monitoring Tissue Oxygenation 144 11.1. Evidence of Microvascular Alterations in Sepsis 144 11.2. Visualization of Microcirculation at Bedside 145 11.3. Measurement of Tissue PO2 or SO2 146 11.4. Occlusion Tests 146 11.5. NADH Fluorescence 147 11.6. Indirect Measurements: Tissue CO2 Measurements and Microdialysis 147 11.7. Should we Measure Tissue Oxygenation, Tissue Perfusion or Markers of Anerobic Metabolism? 148 11.8. Measurements of Tissue Oxygenation in Other Conditions than Sepsis 148 11.9. Conclusions 148 Index 154

240 mm

17 cm