Hemodynamic Monitoring

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Hemodynamic Monitoring

• Gilbert Handal, M.D.

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Monitoring of Shock

• I. Evidence of Hypoperfussion
• Clinical irritability
• Decreased conscious state
• Decreased urine output
• Poor peripheral perfusion
• Capillary Refill gt 5 sec
• Thready pulse
• Body surface to / ratio with core to
• Body surface to / relation to env.to

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Monitoring of Shock

• Blood Pressure
• Systolic Nl or ? good ventricular ejection
• Diastolic ? s. vasodilatation
• Systolic ? poor ventricular ejection
• Diastolic ? s. vasoconstriction

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Monitoring Shock

• Central venous pressure (measures LVEDV)
• Low Hypovolemia
• Nl or high Does not rule out
• hypovolemia

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Monitoring of Shock

• Non invasive hemodynamic monitoring
• Doppler ultrasonography measures velocity of
  blood as it moves through the heart
• Systolic Function assessed by

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Monitoring Shock

• Gastric intramucosal pH (pHi)
• lt 7.3 ? higher mortality?

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Monitoring Shock

• Lactate
• Fluctuations are rapid (60 minutes)
• Prognosis!!

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Monitoring ShockInvasive

• Swan-Gantz Catheter
• PAWPLV end diastolic volume (except CHF or
  M.I.)
• PAP SVR/PVR allows better use of inotropes
• . CO
• Vascular Resistance
• O2 delivery and consumption

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Complications

• Difficulty of insertion
• Questionable benefits
• Arrhythmias
• Infection
• Thromboembolism
• Lung Injury

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Medications in Children

• Pulmonary Hypertension
• Shock Refractory to Resuscitation
• MOFS

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