Hemodynamics Management

This screenshot you provided shows the monitor of an Impella CP which appears to be positioned in the aorta instead of the correct position within the left ventricle (LV).

• Ao Pressure: 126/73 mmHg (Mean 93 mmHg), indicating the device is picking up aortic pressure signals.

• LV Pressure: There is a loss of clear pressure signals from the left ventricle, which would normally be used to monitor proper positioning.

• The low fluctuation of the motor current, (with readings showing a current of 399/350 mA), suggests that there is minimal pressure gradient across the two pressure sensors of the Impella device. These sensors normally detect pressure differences between the aorta and the left ventricle.

The motor current stability (almost flat) suggests that the Impella is likely not in the left ventricle (as intended) but rather in the aorta. Since both sensors are exposed to aortic pressure, there is little to no pressure gradient detected…

Systolic pressure variation with respiratory movement indicating fluid responsiveness.

VExUS for evaluation of venous congestion in a patient with mixed cardiogenic and distributive shock, acute respiratory failure, bibasilar infiltrates, and acute kidney injury.

Step 1: IVC diameter is 2.5 cm

Step 2: hepatic vein doppler assessment showing reversal of the systolic wave.

Step 3: Portal vein doppler assessment showing more than 50% variability

Systolic blood pressure (SBP) variation with respiratory movement on the ventilator can be used to assess fluid responsiveness in the ICU. The higher the variation above 13% the more likely to respond to fluid. Make sure the rhythm is sinus and tidal volume on the ventilator is adequate to reflect a change in the intrathoracic pressure.

Use of end-expiratory occlusion test in the assessment of volume status and fluid responsiveness: for more details please visit my recent blog at https://www.icureach.com/post/how-end-expiratory-occlusion-test-eeo-test-can-help-assess-fluid-responsiveness-in-icu-patients

IVC collapse with inspiration in a patient with hypovolemia