Hemodynamics Management

Public·269 members

September 20, 2024

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…

Noor Ali Shah

Sep 21

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This is totally new procedure for me.

Jazak Allah khair.

Aug 22

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From the advance monitoring picture showed Map 79 , BP 141/61, CO 7l/min,CI7.0, SVi 91, HR 77/min,SVV 28%, PPV 29%, VO2i 11 ( very low), SVRi is 826 dsm2/cm5. Hb , SpO2, DO2i, PSi values are missing,

SVV 28% and PVV 29% means fluid responsive are strong predictives . SVRi are low while normal value is 1900 to 2400 dynes s m2/cm5.

Conclusion: High PPV and high SVV are predictive of fluid responsive parameters while SVRi is low indicator of vasodilation ( low after load ) indicates distributive shock syndrome. Low O2 consumption value means hypothermic which is common in distributive shock while hypovolumic and cardiagenic shock should be high .

IVC is not collapsing and echo showed good contractility .

Hopefully Dr. Mazen will encourage me as this advance monitoring is not available in our institute.

Edited

Mazen Kherallah

August 17, 2024

Distributive shock with adequate preload indicated by SVV of 10%, high SV and cardiac output, and low SVR. On levophed, epinephrine, and vasopressin. Lactic acid 13.

Aug 17

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A case of distributive shock, preload is adequate as shown CVP 14 , SVV is 10 % , SV , CO and CI are high , Very low SVR 411. On triple vasopressors but lactate is very high 13.

Clinical history in details is important.

I will optimise the vasopressors especially noradrenaline infusion according to SVR and UOP. I will recommend to add a small dose of dobutamine to improve tissue perfusion which will help in lowering down the lactate levels and will check lactate levels frequently to know the right path of resuscitation and management. I will do SCvO2 level and HB value . As per protocol I will treat the underlying cause as soon as possible. In case of septic shock, initiation of adequate and appropriate antibiotics will be given accordingly.

I will do liver function test , as in liver dysfunction the lactase level remains high.

I will check renal function test and close eyes 👀 on UOP.

Edited

Mazen Kherallah

August 15, 2024

Shock with cytokine release syndrome on norepinephrine and vasopressin in addition to steroid.

Aug 16

The EV 1000 has both thermodilution + pulseconture (which require special condition)

It looks to be missing some data (it could be missing the thermodilution thermostat for the CVC?)

From the only available data:

- distributive shock

- cardiac function are already optimised (CO, CI)

- PVR still low, but systematic flow is supplied (MAP)

- Preload (we need more data, specifically setting, rhythm, breath generation, Tv), GEDV, (CVP: the volume is not depleted), EVLW

Mazen Kherallah

January 28, 2024

Intravenous Levothyroxine for Unstable Brain-Dead Heart Donors | NEJM

Shocks

Mazen Kherallah

October 7, 2023

For the same arterial blood pressure, each organ gets different blood flow due to difference in the resistance of that organ's arterioles.

By reducing the MAP, we will get different change in the blood flow to different organs, e.g the kidneys have significant drop in blood flow compared to the liver for the same level of blood pressure drop this because the kidney has a low resistance compared to the liver which has high resistance, that is why the kidneys are affected significantly at any drop in the blood pressure compared to the liver which requires deeper drop in the blood pressure (it is common to see ATN due to hypotension compared to shocked liver).

Shocks