Clinical application of hemodynamic measurements

what are clinical indicators and measured variables

cardiac output and heart rate

what does central venous monitoring include

right atrial pressure and central venous pressure

what pressure is measured in the pulmonary artery

pulmonary artery pressure

what is the average pressure in the pulmonary artery

mean pulmonary artery pressure

what indicates left heart filling pressure

pulmonary capillary wedge pressure

what is another diastolic measure from the pulmonary artery

pulmonary artery end-diastolic pressure

what is the normal range for RAP and CVP

< 6 mmHg

what is the normal range for PAP

20-30/6-15 mmHg

what is the normal range for MPAP

10-20 mmHg

what is the normal range for PCWP

4-12 mmHg

what is the normal range for CO

4-8 l/min

what is the normal range for HR

60-100 bpm

what is the normal BP range

120/80 mmHg

what is the normal MAP range

80-100 mmHg

what is cardiac index

the volume of blood pumped by the heart each minute, normalized for a person's body surface area

what is stroke volume

amount of blood ejected per beat

what is stroke volume index or stroke index

stroke volume adjusted for body surface area

what is systemic vascular resistance

resistance in the left heart

what is systemic vascular resistance index

SVR adjusted for body surface area

what is pulmonary vascular resistance

resistance in the right heart

what is pulmonary vascular resistance index

PVR adjusted for body surface area

what is left ventricular stroke work index

work done by the left ventricle per beat indexed

what is right ventricular stroke work index

work done by the right ventricle per beat indexed

what are ventricular function curves used for

assess ventricular performance and response to preload

what does zone I on a PCWP vs CI curve indicate

normal or hyperdynamic state such as septic shock

what does zone II on a PCWP vs CI curve indicate

fluid overload with normal contractility

what does zone III on a PCWP vs CI curve indicate

hypovolemia

what does zone IV on a PCWP vs CI curve indicate

acute left sided heart failure with decreased contractility

what does a high PCWP suggest

pulmonary edema

how do you clinically assess cardiac index

evaluate pulse strength and capillary refill

in hypovolemic shock, is pulmonary edema present

no

in hypovolemic shock, what happens to PCWP

decreased

in hypovolemic shock, what happens to PAP

variable

in hypovolemic shock, what happens to PVR

normal

in hypovolemic shock, what happens to cardiac output

decreased

in hypovolemic shock, what happens to SVR

increased

in hypovolemic shock, what happens to MAP

decreased 

in septic shock, is pulmonary edema often present

often

in septic shock, what happens to PCWP

normal or decreased

in septic shock, what happens to PAP

variable

in septic shock, what happens to PVR

variable

in septic shock, what happens to MAP

decreased

in cardiogenic shock, is pulmonary edema present

yes

in cardiogenic shock, what happens to PCWP

increased

in cardiogenic shock, what happens to PAP

increased

in cardiogenic shock, what happens to PVR

normal

in cardiogenic shock, what happens to cardiac output

decreased

in cardiogenic shock, what happens to SVR 

increased 

in cardiogenic shock, what happens to MAP

decreased

in pulmonary embolus, is pulmonary edema present

no

in pulmonary embolus, what happens to PCWP

normal

in pulmonary embolus, what happens to PAP

increased

in pulmonary embolus, what happens to PVR

increased

in pulmonary embolus, what happens to cardiac output 

variable 

in pulmonary embolus, what happens to SVR

normal

in pulmonary embolus, what happens to MAP

normal

in ARDS, is pulmonary edema present

yes

in ARDS, what happens to PCWP

normal or decreased

in ARDS, what happens to PAP 

variable 

in ARDS, what happens to PVR 

variable 

in ARDS, what happens to cardiac output

variable

in ARDS, what happens to SVR

variable

in ARDS, what happens to MAP

variable

in dehydration, is pulmonary edema present

no

in dehydration, what happens to PCWP

decreased

in dehydration, what happens to PAP

decreased

in dehydration, what happens to PVR

variable

in dehydration, what happens to cardiac output

decreased

in dehydration, what happens to SVR

increased

in dehydration, what happens to MAP 

decreased 

with mechanical ventilation + peep, is pulmonary edema present

dependent on condition

with mechanical ventilation + peep, what happens to PCWP

increased

with mechanical ventilation + peep, what happens to PAP

normal or increased

with mechanical ventilation + peep, what happens to PVR

normal or increased

with mechanical ventilation + peep, what happens to cardiac output 

normal or increased 

with mechanical ventilation + peep, what happens to SVR

normal or increased

with mechanical ventilation + peep, what happens to MAP

normal or decreased

what is the purpose of continuous monitoring

assess therapy effectiveness modify based on patient response evaluate effects of drugs fluids ventilation

how is increased preload managed

vasodilators inotropes decreased ventilation pressures

how is decreased preload managed

iv fluid therapy diuretics

how is increased SVR managed 

vasodilators fluids if BP falls after vasodilation inotropes with caution blood or fluids if hypovolemic managed

how is decreased SVR managed

vasopressors

how is abnormal contractility managed if pulmonary edema not present

iv fluids

how is abnormal contractility managed if pulmonary edema present

diuretics

what other measures help manage abnormal contractility

vasodilators after volume optimized inotropes after volume optimized intra-aortic balloon pump negative inotropic drugs maintain electrolyte balance especially K+

what indicates low output states

drop in BP, CO with poor perfusion

what hemodynamic pattern suggests hypovolemia

low MAP, low CO, low PCWP

how is volume status assessed

check CVP, high CVP means volume is not low

what pattern suggests right heart issue

high CVP, normal PAP and PCWP

what pattern suggests lung issue

high CVP and PAP, normal PCWP

what pattern suggests cardiac failure or tamponade

high CVP, high PCWP, high PAP

what pattern suggests left heart issue

low CVP, high PCWP

what pattern indicates cardiogenic shock

low BP, low CO, high PCWP, high CVP