Workbook on Hemodynamic Management Sameer Jog, Kayanoosh J Kadapatti, Sunitha Binu Varghese
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Acetate 31
Acidosis 72
Activated partial thromboplastin time 74
Acute cor pulmonale, evidence of 170
Acute coronary syndrome 173
components of 198
Acute heart failure 198
Acute respiratory distress syndrome 8, 33, 84, 89, 170, 221, 245, 265
Acute right ventricle
dysfunction 237
pathogenesis of 85
failure, pathophysiology of 85
specific clinical scenarios of 89t
Addison's crisis 69
Adenosine
diphosphate 230
triphosphate, hydrolysis of 230
Adenylate cyclase stimulators 88
Adequate monitoring-guided interventions 229
Adrenaline 62, 64
Adrenergic agonists 61
Advanced hemodynamic monitoring devices, classification of 204
Albumin 29, 30
Alcohol swabs/wipes 154
Alteplase 82
Alveolar-capillary barrier 222
American College of Cardiology 196, 251
American College of Obstetricians and Gynecologists 251
American Heart Association 4, 196, 251
Amikacine 259
Aminoglycoside 260
Amiodarone 122, 268
Amphetamine 247
Ampicillin 260
Anaerobic metabolism, end-product of 231
Anemia, severe 99
Anesthesia, induction phase of 230
Aneurysm 211
Anoxic brain damage 44
Anterior mitral leaflet, systolic anterior motion of 161
Anteroseptal T-wave inversion 84
Antibiotic
coated catheters 154
lock therapy 259t
Anticoagulants 148
Antimicrobial therapy 260t
Aortic
aneurysm 222
blood flow proportions 213
dissection 77, 167
regurgitation 144, 145
root 177
stenosis 77, 144, 211
valve 141
level, short-axis view 156, 157
stenosis 161
Arrhythmia 125, 174, 192
life-threatening 47
management 47
presence of 174
Arterial blood
gas 45, 168
pressure 111, 261, 270
Arterial carbon dioxide difference 66
Arterial pressure 74, 237
diastolic 262
waveform 107
Arterial pulse 138
contour analysis 211, 220f
waveform, normal 140f
Arterial puncture 125
risk of 151
Arterial resistance 27f
Arterial system, realistic model of 134
Arterial tree 134, 135f
model of 133
Arterial vasodilator 168
Arterial waveform 138, 139, 144, 145
shape of 142f
understanding and interpreting 132
Arteriolar narrowing 250
Arteriovenous fistulae 112
Artery disease, coronary 171
Asepsis 148
Atmospheric pressure 106
Atria-caval junction 161
Atrial
contraction 116, 129
fibrillation 130
myxoma 181
Atrioventricular
fistula 158
valve 116
Autoimmune disorders 195
Autonomic tone 52, 55
B
Bacteremia 257
Bacterial infection
biomarker of 195
concomitant 195
Balanced crystalloids 5
group 31
solution 231
Balanced salt solutions 31
Balloon rupture/leak/embolism 192
Balloon tipped flotation catheter 180
Barotrauma 83
Basic hemodynamic monitoring 203
Bazett's formula 213
Beck's triad 80
Bernheim's effect 78
Beta blockers 237
Bifid waves 131f
Biofilm 257
Biomarker quantifying cardiomyocyte injury 198
Biventricular systolic function, evaluation of 173
Bleeding
complications 151153
excessive risk of 215
Blood
Flow
biphasic ejection of 144
coronary 117
lactate 175f
loss 72
pressure 56, 72, 159, 247, 249f, 250, 251, 253, 267, 268
control, disease-specific targets for 251t
diastolic 37
general goals of 250t
monitoring 237
products, transfuse multiple units of 72
volume contraction 70
Bloodstream infection 254
Brachiocephalic vein 152
Bradycardia 262
Brain NP testing, uses of 196
Breath sounds, absent 78
Broad spectrum antibiotic 256
Bronchoalveolar lavage 221
Bulmonary thromboembolism 78b
Burns 195
C
Calibrated pulse contour analysis devices 210
Candida 259
Candidemia 257
Capacitance vessels 28
Capacitative sensors 110
Capillary leak 33
Capillary refill time 21, 73, 262, 267, 268
Carbapenem 260
Carbon dioxide 230, 262
partial pressure of 264, 267
Cardiac
apex, short-axis view 156, 158
arrhythmias 3, 12
biomarkers 82
chambers 53
failure, severe 146
function 55
curve 28f, 112f
index 220, 221
index 44, 191, 231, 232
isolated value of 224
natriuretic peptides 195
output 21, 27, 47, 61, 71, 74, 102, 175, 183, 211, 216, 219f, 229, 236, 264, 267, 268
adequacy of 269
continuous 217, 243
curve 190f
devices 210
measurement of 16, 180, 188
monitoring 39, 238
response of 9
perforation 125
preload 34
static indices of 8
probe, selection of 156
response curve 28
structures 182
surgery 67, 89
high risk 180
tamponade 3, 77, 78, 78b, 80, 82, 131, 158, 167, 168
troponin 194, 198
Cardiogenic pulmonary edema, management of
Cardiogenic shock 39, 41, 44, 51, 63, 77, 180
diagnosis of 41
evaluation 45
management of 44, 45, 64, 65
medical management 46
therapeutic management 45
Cardiomyopathy 146
sepsis induced 91
Cardiovascular
failure 174
function 264
homeostasis 175f
mainstays of 174
system 217, 248
Catheters
handling of 154
related bloodstream infections 254
transducer system 107
types of 122, 148
Cefazolin 260
Cellular dysfunction 97
Central arteries 144
compliance of 140
Central line
associated bloodstream infection 254
insertion, procedure of 147
Central nervous system 248
Central pulmonary artery 185
Central vagal tone, blockade of 55
Central venous catheter 70, 92, 173, 208, 230, 254
Central venous line
cannulations 147
placement, site of 148
Central venous oximetry 99
Central venous oxygen
saturation 46, 92, 97, 208, 230, 236, 264, 267, 268
low level of 65t
Central venous pressure 21, 46, 53, 71, 74, 93, 94, 111, 112f, 114, 118, 121, 158, 174, 175, 183, 203, 208, 222, 237, 240, 262, 267
compliance, and volume 113
determinants of 112
flow, volume, and time 112
interpretation value 115
line 123
measuring 109
monitoring 111
static measurements of 236
understanding use in today's scenario 117
waveforms 129
interpretation of 116t
Central venous saturation 175
Cerebral
hypoperfusion 249f
microvasculature autoregulation 249f
Chest pain, acute 173
Chest trauma 173
Chlorhexidine 123, 154, 255, 256
Chromophores 23
Chronic obstructive pulmonary disease 67, 82, 171
Chronic thromboembolic pulmonary hypertension 66
Chronotropy 61
Circulatory failure
acute 21, 261
indicator of 269
managing 170
various types of 105
Circulatory shock 21, 105, 268
criteria of 203
Classical Seldinger's technique 154
Coagulopathy 72, 122
Cocaine 247
Cold saline, injection of 222
Cold shock 69
Collecting blood cultures, method of 255
Colloids 29
cost of 29
Compensatory peripheral vasoconstriction 44
Compensatory sympathetic vasoconstriction 262
Compute systemic vascular resistance 240
Computed tomography 250
pulmonary angiography 80
Continuous flow devices 50
Continuous renal replacement therapy 48, 158
Continuous veno-venous hemofiltration 221
Cor pulmonale, acute 116, 170
Coronary artery bypass grafting 45, 49
Cotton-wool spots 250
Critical aortic stenosis 83
Critical care echocardiography 158, 170
advanced 171
indications of 214
main indications of 215
Critically damped system 108
Crystal semiconductors 110
Crystalloid 29, 31
boluses of 260
drawback of 30
proponents 29
solution, use of 74
use of 30
Cytochrome oxidase 23
Cytokines production 91
D
Daptomycin 259, 260
D-dimer 194, 197
assays, limitations of 197
Deceleration injury, severe 173
Deep vein thrombosis 80
Dextrans 30
Dicrotic notch 141
Dicrotic wave 146
Digital ischemia 35
Dilutional coagulopathy 74
Disseminated intravascular coagulation, diagnosis of 197
Distensibility index 175
Dobutamine 47, 6266, 88, 100
Dopamine 47, 64
Doppler
echocardiography 238
monitoring devices 242
techniques 265
velocimetry 112
Down-slope time 219f
Durable mechanical circulatory support 50
Dye indicator dilution method 189
Dynamic end-expiratory occlusion tests 204
Dynamic left ventricular outflow tract, setting of 161
Dyspnea, acute 196
Dysrhythmias, high risk 181
E
Early goal-directed therapy 65, 91, 93, 100
protocol 92, 92fc
trials 65t
use of 95
Echinocandin 259, 260
Echocardiography 45, 156, 157, 173, 175f, 214, 265
advanced 157
application of 173
disadvantages of 265
indications of 173
Electrocardiogram 236
Electrocardiography signs 84
Elevated filling pressures, causes of 166
Emphysematous bullae, rupture of 82
Enalaprilat 252
End-diastolic volume index 266
End-expiratory occlusion test 14, 59
End-inspiratory occlusions 14
Endocarditis 41, 192
infective 173
right-sided 181
Endocrinopathies 247
End-organ hypoperfusion 44
Endothelial basement membrane 29
Endothelial glycocalyx 29
disruption of 61
Endotracheal intubation 5
Enoximone 47, 64
Enteric gram-negative bacilli 258
Enterococci 258, 259
Epinephrine 47, 99
Esmolol 252
Esophageal
disease 215
Doppler 16, 212
perforation 45
Esophagogastric surgery 215
European Society of Cardiology 251
European Society of Intensive Care Medicine 157
Excess fluid resuscitation 203
Exogenous vasopressin 36
External end-diastolic diameter 87
Extra-alveolar vessels, tortuosity of 55
Extracardiac pressure 114
Extracellular matrix 29
Extracorporeal carbon dioxide removal 102
Extracorporeal membrane oxygenation 102, 156, 208
Extrathoracic organs 111
Extravascular lung water 70, 211, 219, 221, 239
index 208, 217, 220222, 240, 266
F
False positive test 195
Fast flush test 108
Femoral arterial punctures 237
Femoral vein 121, 152, 222
cannulation, complications of 153
catheterization 123, 127, 127f
Fenoldopam 252
Fibrinolysis 48
Fick equation 264
Fick method 189
Fick principle adapted 230
Filling pressures, reduction of 169
Fixed septal flattening 178
Flotrac vigileo system 241, 241f
Fluconazole 258
Fluid
administration 39
challenge 9, 266
for resuscitation, type of 30
pathophysiology of 70
restrict 156
resuscitation 26, 29
restores intravascular volume 31
therapy with crystalloid infusion 229
Focused left heart examination 176
Fourier's analysis 107, 136, 137
Frank-Starling curve 8
Fulminant catheter-related bloodstream infection 254
Functional residual capacity 59
Furosemide, small dose of 166
G
Gastrointestinal tract 21
Gelatins 29
Geneva score 197
Glasgow coma scale score 72, 79
Glimepiride 267
Global ejection fraction 220, 221, 240
Global end-diastolic volume 211, 217, 220, 222, 239, 240, 245
assessment of 219
Global left ventricular systolic function 165
Global right ventricular systolic function 166f
Gluconate 31
Glycocalyx 6, 32
Glycopeptide 260
Goal-directed therapy 236
Gram negative bacilli 259, 260
Guidewire, postinsertion of 154
H
Heart
block, complete 129
disease, ischemic 229
failure 196
acute 195
chronic 99
congestive 171, 196
right 66
rule-out test 195
weaning-induced 67
lung interactions
clinical application of 57
during mechanical ventilation, understanding 52
use of 57
pumps 27f
rate 12, 72, 211, 230, 231, 233, 237
control 102
transplantation 45, 50, 116
Hematocrit 65
Hematoma 192
Hemisensory defects 249
Hemodynamic 60
assessment, noninvasive methods of 209
challenges, management of 209
data, use of 66
effect 47
instability 33, 47, 173
episode of 224
harmful consequences of 229
insufficiency 194
significant biomarkers of 194
investigation of 174
measurements 53
monitoring 39, 203, 237, 254, 255
advanced 201, 203, 209, 216
devices 41, 203205
effect of 41
methods 236
modalities of 238
system 210
technique 13
tool 173, 179, 238, 266
parameters
variety of 240
worsening of 224
protocol, device-based 205
resuscitation, targeted approach of 91
state
assessment of 266
evaluation of 265
status 173, 236
monitoring of 70
optimization of 236
target parameter 234
technique 174
variables, evolution of 231
waveform 187
Hemodynamically unstable, management of 231
Hemoglobin 65, 74, 192, 267
Hemorrhage 192, 250
Hemorrhagic shock
classic lethal triad of 72
management of 73, 74fc
Hemothorax, higher incidence of 152
Hepatic function tests 45
High cardiac output states 190
High osmolar drugs 147
High positive end-expiratory pressure 47, 55, 174
High-capacitance system 85
High-lactate concentrations 231
Hot shock 69
Hydralazine 252
Hydrogen ions 230
Hydroxyethyl starch 29
solutions 6
Hyperadrenergic states 247
Hyperchloremic acidosis, problems of 73
Hyperdynamic 177
circulation 97
Hyperlactatemia 97, 98
causes of 98, 99t, 263
Hyperlactemia, sepsis related 22
Hyperoxemia, negative impact of 5
Hypertension 249
abdominal 8
accelerated 247
acute severe 247
chronic 248
history of 229
intra-abdominal 12
intracranial 17
malignant 247
Hypertensive crisis 247
secondary causes for 248t
Hypertensive emergencies 247, 248t
common drugs for treatment of 252t
drug of choice in 251t
Hyperthermia 99
Hypertonic saline 147
indicator 217
Hypertrophic obstructive cardiomyopathy 144
Hypervolemia 111
Hypoperfusion 33
evidence of 98
signs of 269
Hypotension 33, 35, 78, 173, 208
intraoperative 238
Hypothermia 72
Hypovolemia 3, 5, 8, 33, 111, 119f, 161
persistent 33
sign of 160
Hypovolemic hemorrhagic shock, classification of 72t
Hypovolemic shock 41, 69, 70, 71fc
management of 72, 73fc
monitoring 70
Hypoxemia 173
severe 102
Hypoxia 192
severe 99
Hypoxic stimulus 35
Hypoxic vasoconstriction 221
I
Incisura 141
Inferior vena cava 13, 78, 156, 174, 175
Infundibulum 85
Injury, ischemic 72
Inotropes 64, 65, 67, 102, 158
physiology of 61
role of 67
therapy 224
use 66
Inotropic agents 41, 42, 47t, 61, 92
Inotropic support 203
Inotropy 61, 63
Inspiration collapse 176t
Intensive care unit 4, 8, 33, 52, 61, 157, 121, 132, 147, 173, 203, 208, 210, 216, 254
setting of 86
Intensivist visualize cardiac anatomy 173
Interatrial septum 160, 161
Intermittent positive pressure ventilation 52, 54fc
Intermittent thermodilution technique 189
Internal jugular central vein cannulation, complications of 151
Internal jugular vein 121, 147149, 150f, 181
catheterization 126, 127f
Interstitial edema 26
Interstitial lung disease 171
Interventricular septum 160, 161
Intra-abdominal compartment syndrome, worsening of 74
Intra-abdominal pressure 52, 161
Intra-aortic balloon pump 49, 144, 145f, 156
Intra-arterial pressure monitoring systems 138
Intracranial pressure 237
Intrapericardial pressures, elevated 170
Intrapleural pressure 53, 114
Intrathoracic blood volume 59
Intrathoracic pressure 5, 11, 15, 52, 244
variations, irregularity of 13
Intrathoracic thermal volume 211, 220
Intrathoracic transmural pressure 53
Intrathoracic vascular pressures 187
Intravascular pressure transducer 105
Intravascular volume 29, 236
assessment 174
Intravenous fluid 29
development, history of 26
Invasive pressure monitoring 105
Ipsilateral hemothorax 122
Ipsilateral indwelling central vascular devices 122
Isoproterenol 47
Isovolumic relaxation time 175
J
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 250
Jugular line insertion 82
Jugular vein 123
K
Kidney
disease 171
injury 79
Krebs cycle 97
L
Labetalol 252
Lactate 31, 98
understanding and interpreting 97
Lactic acid, production of 230
Lactic acidosis 97
Laryngeal injury 125
Lateral tricuspid annulus, peak systolic velocity of 165
Left atrial
filling pressures 187
myxoma 187
pressure 174, 183, 184, 188
volume 162f
Left bundle branch block 78
Left internal jugular vein 125
Left side filling pressure 166
Left subclavian vein 125
Left ventricle 52, 54, 56, 59, 160, 174, 175, 192, 222
preload, accurate reflection of 183
Left ventricular 173
assessment 176
contractility 158
contraction, force of 140
diastolic function 166
dimensions 161
dynamic outflow tract obstruction 168
ejection fraction 158
end-diastolic pressure 64, 183, 187, 188, 192
end-diastolic volume 56, 183, 188
function 57
hypertrophy 161, 250
outflow tract
diameter, values of 165
dimensions 162f
stroke
volume 141, 165
work index 191
Leptospirosis 67
Levoflox 259
Levosimendan 47, 62, 6466, 67, 88
effect of 67
meta-analysis of 65
LiDCO systems 240
Lidco device 239
Lidco system 241
Lignocaine 123
Liposomal amphotericin 259b
Lithium
accumulation, potential toxic effect of 212
dilution cardiac output 211
Liver
disease 99
dysfunction, severe 195
failure 263
function tests 46
Local microbacterial flora 256
Lung
edema, marker of 266
protective ventilation 174
resection 221
sliding, absence of 78
water, estimation of 221
zones 187
M
Marey's sphygmograph 133f
Massive pulmonary embolism 77, 80, 96
Massive transfusion protocol 73
McConnell's sign 87
Mean arterial
blood pressure 21, 33, 37, 65, 92, 95, 97, 140, 230, 261
pressure 175f, 231, 240, 249
Mean circulatory filling pressure 27
Mean systemic pressure 27, 27f
Mean transit time 219f
Mechanical circulatory support 45, 49, 88
Mechanical ventilation 5, 14, 59, 171, 174
primary indications of 47
Mechanically assisted circulatory support 51
Mediastinal radiation therapy 215
Mental status 46
Mesenteric ischemia 35
Metabolic parameter 97, 263, 269
Metformin 267
Microbes, migration of 257
Milrinone 47, 62, 63, 88
use for cardiac dysfunction 64
Mini fluid challenge 10
Mitochondria 97
Mitral annulus, tissue Doppler of 175
Mitral inflow Doppler 163f
Mitral insufficiency 211
Mitral regurgitation 45
Mitral valve
level, short-axis view 156, 158
stenosis 161, 187
Mixed shock states 180
Mixed venous oxygen saturation 180, 191, 192, 208, 217, 238, 240, 264
Monoamine oxidase inhibitor, use of 249
Mottling score 263
Muffled heart sounds 78
Multiorgan
dysfunction 33
failure 69, 72
Multiple vasopressors 36
Multivessel coronary artery disease 49
Myocardial contractility 61, 63
Myocardial dysfunction
presence of 237
sepsis induced 65
Myocardial fibers 85
Myocardial infarction 3, 44, 74, 84, 173, 195, 196, 198
Myocardial injury 45
Myocardial ischemia 35, 62, 253
Myocardial kinesis 238
Myocardial necrosis biomarker levels 45
Myocardial oxygen consumption 46
Myocardial systolic velocity 165
Myocardial thickness 238
Myocarditis 41
Myoglobin acts 23
N
Natriuretic peptide
B type 195
persistent elevation of 196
Near-infrared spectroscopy 235
principle of 23
Needle migration, risk of 154
Negative pressure pulmonary edema 57
Nicardipine 252
Nitric oxide 88, 168
synthase 44
Nitroglycerin 252
Nodal tachycardia 129
Noncalibrated devices 240
Noncardiac surgery 89
Nondiagnostic complementary tests 173
Noninvasive blood pressure 236
monitoring 237
Noninvasive cardiac output monitoring 41
Noninvasive clearsight system 241f
Noninvasive pulse contour analysis 241
Non-invasive ventilation 60
Non-ST-segment-elevation acute coronary syndrome 45
Nontunneled catheters 122
Nonvasoactive medications 46
Nonvital organs, vasoconstriction of 21
Noradrenaline 6, 34, 36, 46, 47, 64, 75
Norepinephrine
high dose of 35
initiation of 35
Normogram-based calibration factor 212
Normovolemia 232
N-terminal pro brain natriuretic peptide 194, 195
O
Obstructive shock 77
categorization of 77t
causes of 83
evidence of 168
management of 77
pathophysiology of 77, 79fc
symptoms and signs of 77, 78t
Oncotic pressure gradient 29
Ongoing tissue hypoperfusion, harmful effects of 203
Optimal cardiac function 119f
Optimal pressure monitoring system 186
Organ dysfunction 195
life-threatening 91
Organ perfusion pressure 118
Orthogonal polarization spectral 235
Overdamped system 109
Oxide donors 88
Oxygen
administration 229
consumption 193, 267, 269, 270
delivery 191, 192, 193, 229, 243, 267270
early optimization of 99
main determinants of 188
optimization 243
extraction ratio 193
saturation 91, 191
transport variables 191
uptake 191
P
Pacemaker 122
Packed cell volume 212
Pancreatitis 69
Papillary muscle
level, short-axis view 156, 158
rupture 41, 181
Papilledema 250
Paradoxical septal motion 178
Passive leg raising 9, 70, 167, 175, 208, 244
principle 15
test 10, 17t, 204, 265
Patent foramen oval 74
Peak pulmonary flow 163
Peak velocity 208
Penetrating chest trauma 82
Percutaneous coronary intervention 45, 48
Percutaneous noncoronary cardiac procedures 173
Perfusion pressure 262
Pericardial collections besides inferior vena cava 238
Pericardial diseases, constrictive 57
Pericardial effusion 45, 114, 161, 179
moderate amount of 158
presence of 168
size of 158
warranting drainage 170
Pericardial rub 78
Pericardiocentesis 82
Pericarditis, constrictive 77, 131
Peripheral arterial tone 175f
Peripheral artery 141, 144
pulse waveform 142
Peripheral capillary oxygen saturation 5
Peripheral inserted central catheter line 153
Peripheral oxygen saturation 236
Peripheral perfusion
assessment parameters 21
index 23, 262
Peripheral veins 122
Peritonitis 4
Permissive hypotensive resuscitation 75
Pharmacology
adrenaline 62
amrinone and milrinone 63
dobutamine 62
levosimendan 63
Phentolamine 253
Phenylephrine 47
Phenytoin 122
Pheochromocytoma 247
Phlebostatic axis 106
Phosphodiesterase inhibitor 61, 62, 88
PiCCO device 220, 239, 240
Piezoresistive sensors 110
Piperacillin 259
tazobactum 260
Plasma
hemofiltration 118
unit of 73
Platelet, unit of 73
Plethysmographic variation index 70
Plethysmography signal 11
Pleural pressure, proportion of 53
Pleuritic chest pain 78
Plotted against time 139
PLR test 16
Pneumothorax 45, 122, 125, 192
higher incidence of 152
Poisoning/overdose 67
Positive end-expiratory pressure 114, 158, 221, 230
application of 186
increases intrapleural pressure 187
reduction of 102
Positive pressure ventilation 175
Postcardiac interventions 82
Postcardiac surgery 82
Postinsertion 154
Potassium 122
Prazosin 68
Preconception and prenatal diagnostic techniques act 157
Predict fluid responsiveness 233
Preload
dependence, case of 10, 11
responsiveness 222, 264, 265
safety 222
marker of 205
Preserved ejection fraction 159
Pressure
curve, shape of 211
evaluations 174
level of 158
monitoring system components 106
transducer system 123
waveform
demonstrates 183
overdamping of 109
Procalcitonin 194, 195
Prominent pulse pressure variation, positive of 167
Protean hemodynamic monitoring techniques 69
Prothrombin time 74
Pseudomonas 258
Pulmonary acceleration time 163, 164f
Pulmonary annulus, level of 167
Pulmonary arterial
hypertension 89
pressure 188
Pulmonary artery 174, 218
blood 191
catheter 122, 173, 180, 181, 188, 192, 208, 212, 217, 238, 239f, 267
complications of 184, 192
ports 181f, 182
use of 46, 180
flow
acceleration time 175
waveform 167
occlusion pressure 53, 67, 175, 182, 184, 188, 208, 222, 237, 265, 266
outflow pattern 163
pressure 164f, 183, 184, 185f, 192
accurate 186
probes 263
rupture 192
systolic pressure 166
wedge pressure 184, 187
Pulmonary capillary wedge pressure 44, 70, 71, 180, 183, 184, 185f, 187, 192, 236
Pulmonary circulations 27
Pulmonary disease
advanced 187
chronic 60
Pulmonary edema
cardiogenic 59
congestive 245
Pulmonary embolism 3, 69, 173, 196, 198, 237
acute 84, 168
non-high risk 197
recent advance in management of 80
risk factors of 78b
Pulmonary hypertension, severe 181
Pulmonary infarction 192
Pulmonary nor transpulmonary 16
Pulmonary pressure 117
Pulmonary thermal volume 211
Pulmonary thromboembolism 78, 82
diagnostic tests 80
management 80, 81fc
Pulmonary valve replacement 181
Pulmonary vascular permeability index 208, 220, 222, 240, 266
normal value of 222
Pulmonary vascular resistance 46, 47, 52, 191
Pulmonary vasculature, vessels of 221
Pulmonary vasodilator 168
Pulmonary vein 175
inflow pattern 163
Pulmonary venous pressure 187, 188
Pulsatile
flow 135
pressure 135
pump 50
Pulse contour
analysis method 238
cardiac output 210
systems 209
Pulse oximeter signal 23
Pulse pressure 58, 72, 261, 262
variation 12, 37, 56, 58, 174, 208, 231, 232, 232f, 236, 261
clinical use of 58t
limitations of 233t
stroke volume variation 10
Pulse rate 107
Pulse volume 73
Pulse wave Doppler 163
Pulseless electrical activity 79
Pulsus bisferiens 144
Pulsus paradoxus 57, 78
Pump 5
Pyruvate, formation of 97
R
Ramipril 268
Red blood cell 250
transfusion 42
Reduced systemic vascular resistance 167
Reduces intrathoracic blood volume 59
Reflected pressure waves 141
Regurgitations 166
Renal failure 196
Renal replacement therapy 122
Renin-angiotensin-aldosterone system antagonists 46
Replaced fluoroscopic guidance 179
Respiration, identical phases of 161
Respiratory
failure 170, 173
occlusion tests 14, 15
rate 12, 72, 233
systolic variation test 15
Resuscitation
cardiopulmonary 208
protocol, device-based 209
useful marker of 264
Reteplase 82
Reverse Bernheim's effect 78
Right atrial pressure 27, 28f, 52, 53, 74, 112f, 175, 183, 192
accurate measurement of 187
waveforms 183f
Right atrium 116, 174, 176, 192, 183, 160
venous refilling of 116
Right bundle branch block, complete 84
Right internal jugular vein 125, 150f
Right jugular vein 230
Right subclavian vein 125
Right ventricle 52, 54, 56, 84, 174, 175, 176
end-diastolic pressure 129
free wall collapse 170
playing spoilsport 168
size of 160
Right ventricular 173
assessment 177
contractility 160
dysfunction 89
ejection fraction 166
end-diastolic volume 55
global systolic function 169f
infarction 89, 181
myocardial infarction 77, 168
outflow tract 165
peak velocity 164f
pressure 184
trace 184
waveform 184f
stroke work index 191
systolic function 165
Rule out test 196
S
Sarcoplasmic reticulum 61
Sclerosis 250
Scorpion bit 67
Seldinger's technique 121, 123, 124f, 154
modified 154
Semisynthetic colloid 30
development of 27
effects of 32
Sepsis 4, 91, 95, 100, 194, 195
campaign 33, 37, 91
severity of 98
shock 91
timely recognition of 95
Septal dyskinesia 84
Septic shock 33, 36, 37fc, 41, 91, 92, 95, 101, 105, 194
Serum lactate 97, 263, 269
Severe vasoconstriction, presence of 237
Shivering 99
Shock 69, 97, 99, 208
in trauma 71
induced endotheliopathy, pathophysiology of 71f
jugular venous pressure syndrome 80
management epitomizes intensive care medicine 26
mechanism of 167
resuscitation 5, 26, 27
states, hemodynamic profiles of 180t
types of 69, 71t
Shunt fraction 193
Simpson's formula 214
Simpson's method, modified 158
Sinusoidal waves 138
Sitagliptin 267
Skin
mottling 22
temperature 263
Sodium
chloride 31
nitroprusside 168, 252
Spontaneous breathing 12, 55
Spontaneous pneumothorax 83
Stable stroke volume 112
Standard fluid challenge 9
Staphylococcus, coagulase-negative 258
Starling's theory 28f
Static parameters, inherent limitation of 224
Statin 46
ST-elevation myocardial infarction, mechanical complications of 181
Sterile cannulation set 123
Sternocleidomastoid
clavicular head of 149
muscle, lateral border of 152
Sternum, xiphoid process of 106
Stewart-Hamilton equation 211, 217, 218
Stewart-Hamilton principle 217
Streptokinase 82
superior 48
Stress 99
Stroke volume 56, 58, 74, 211, 216, 236
index 191, 231, 232
measurement 213t
optimization 243
variation 12t, 34, 56, 58, 58t, 70, 167, 174, 208, 211, 218, 222, 223, 236, 240
Subclavian vein 121, 123, 147, 151
cannulation, complications of 152
catheterization 126, 126f
Superior vena cava 13, 161, 183, 192, 208, 216, 222, 238
collapsibility index 175
Suppurative thrombophlebitis 257
Surrogate arterial pulse pressure varying 55
Sweating 78
Systemic vascular resistance 47, 71, 176, 191, 192, 218, 247
index 220, 240
Systolic anterior motion 161
Systolic arterial pressure 15, 44, 74, 94, 132, 222
Systolic septal flattening 178
T
Tachycardia 78
management 66
Tachypnea 78
Tamponade 179
Tazobactum 259
Technique, one person versus two person 148
Teicoplanin 259, 260
Temporary ventricular assist device 45
Tenecteplase 82
Tension pneumothorax 77, 78, 78b, 82, 168
Thermal volumes, calculation of 219, 219f
Thermodilution
curve 218f, 219f
components of 219
measurements 242
method 189
technique 183
Thrombolytic agents 82t
Thoracic aorta 212
Thoracic bioimpedance methods 242
Thorax, cardiac fossa of 55
Thrombin sheath 257
Thrombocytopenia 122
Thrombolysis 45
Thyrotoxicosis 69
Tidal volume 208
challenge 11, 233, 266
test 57
Tissue Doppler imaging 156
Tissue hypoperfusion 91, 266
markers of 262
presence of 268
signs of 269
Tissue oxygen
delivery, check adequacy of 269
saturation 23
Tissue plasminogen activator 48
Trachea, deviation of 78
Transcardio pulmonary thermodilution 211
Transcutaneous oxygen 262
Transducer
development 109
principle of 105
setup 106
Transesophageal 214
Doppler 205
echocardiography 161, 238
disadvantages of 215
limits of 215
Transient cortical blindness 249
Transmitral filling
atrial wave of 175
early wave of 175
Transmural pressure 53, 114
Transpulmonary gradient 46
Transpulmonary thermodilution 41, 217, 221, 265267
parameters, reference range of 220t
technique
advantages of 223
devices 225fc
limitations of 223
techniques 216
use of 267
Transthoracic continuous Doppler CO monitor 242
Transthoracic echocardiography 13, 214, 238
Transvenous pacing 122
Trauma 195
brain injury 74
Tricuspid annular plane systolic excursion 84, 160, 166f, 175
Tricuspid regurgitation 181, 237
jet, absence of 164f
peak pressure gradient of 175
Tricuspid stenosis 129
Tricuspid valve 178
buckling of 116
disease 181
Troponin 194, 198
assay, type of 198
C 198
Tumor
disease, end stage of 195
intracardiac 77, 83
necrosis factor 44
Tympanic membrane 263
U
Uncalibrated pulse contour analysis 212
Unstable neck fracture 215
Urine output 46
Urokinase 82
V
Valve
dysfunction, severe 41
lesions, presence of 166
stenosis 166
surface of 161
trauma 192
Valvular
structure and function 238
suspicion of 173
Vancomycin 258, 259, 260
Vasoactive drugs, delivery of 254
Vasoconstrictor substances, release of 248
Vasodilatory shock, state of 33
Vasoplegia 230
Vasopressin 47
deficiency 36
infusion 36
Vasopressor 33, 34, 41, 64, 66, 75, 158
agents 6
initiation of 33, 34
targets 6
therapy 33
modification of 204
use of 65
Vasospasm 108
Velocity-time integral 175, 178
Vena cava diameter 12
reliability of 13
Vena cava syndrome 77, 83
Vena caval variation 58
Veno-arterial CO2 gap 97, 101
Veno-arterial ECMO, use of 50
Venous-to-arterial carbon dioxide gap 230
Ventilation
one-lung 221
strategy of protective 230
Ventricular assist device 156
Ventricular ejection fraction 238
Ventricular interdependence 55
parallel effect 55
series effect 55
Ventricular pacing 129
Ventricular rupture 45
Ventricular septal
defect 181
rupture 45
Ventricular stroke 212
Ventricular tachycardia, ventricle causing 184
Ventricular walls collapse 160
Ventriculoperitoneal 122
Vignette, case 267
Visceral pericardium 179
Vital signs 73
Volemic status, evaluation of 113
W
Wave
A 129
C 129
P 129
reflection 134
Weaning, pulmonary edema of 59
Wedge position 182
West's lung zones 189f
Wheatstone bridge circuit 106
Windkessel effect 134
Windkessel model 133
World Health Organization 148
Y
Yeasts 258
Z
Zero pressure line 106
×
Chapter Notes

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Workbook on HEMODYNAMIC MANAGEMENT
Workbook on HEMODYNAMIC MANAGEMENT
Editors Sameer Jog MBBS MD (Int. Med.) IDCCM EDIC Consultant Intensivist Department of Intensive Care Medicine Deenanath Mangeshkar Hospital Pune, Maharashtra, India Kayanoosh J Kadapatti MD DNB (Medicine) IDCCM EDIC Head Department of Intensive Care Jehangir Hospital Pune, Maharashtra, India Sunitha Binu Varghese DNB (Med) IDCCM EDIC Head Department of Critical Care Niramaya Hospital Pune, Maharashtra, India Foreword Shirish Prayag
Jaypee Brothers Medical Publishers (P) Ltd
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Phone: +977-9741283608
© 2019, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Workbook on Hemodynamic Management
First Edition: 2019
9789386261007
Printed at:
Contributors Foreword
It is with a great degree of pleasure and pride that I am writing this Foreword.
Critical care in India has spread far and wide and has reached great heights over the last 25 years. Although isolated foci of excellence in Critical Care existed in India in individual centers 25 years ago, there was no organized professional activity. Training in this evolving field was nonexistent. It is then in 1992, that organized platform for discussions in a small group was started in Pune, under the banner of Critical Care Society. In 1993, the Indian Society of Critical Care Medicine (ISCCM) was born and this local activity in Pune merged with ISCCM as its first city branch.
Over the past 25 years of activity, Pune Branch of ISCCM has remained in the forefront of academic activities of ISCCM and the Critical Care world in India. There have been innumerable activities, and all this has led to Pune being awarded the Best Branch award for many consecutive years.
We have always believed in giving something different, unique and enriching to the world of critical care in India. The workbooks for various workshops are therefore a part of this continuing process of dynamic output from this branch.
Hemodynamic management has formed the backbone of Critical Care in the world. In fact, the evolution of critical care medicine as a specialty occurred due to the rising new trends in mechanical ventilation and hemodynamic monitoring and management. From Max Harry Weil to Prof William Shoemaker, the evolution of the field of Critical Care Medicine occurred due to the evolution of hemodynamic management strategies.
Over the last decade or so, this aspect has evolved significantly with a number of well done studies. The era of invasive hemodynamic monitoring has given way to a number of sound non-invasive techniques which need to be understood properly.
This workbook, thus is an important contribution from the Pune Branch of ISCCM towards the better understanding of hemodynamic management. The contributor list is headed by none other than Prof JL Vincent and includes many international stalwarts with significant international publications. The national contributor list is also impressive and all these authors have collectively given this impressive publication.
A wonderful way to commemorate the Silver Jubilee of the Indian Society of Critical Care Medicine!!!
Shirish Prayag MD FCCM
Director Critical Care
Prayag Hospital
Pune, Maharashtra, India
Preface
It is our proud priviledge as editors, to present this book, Workbook on Hemodynamic Management.
The salient features of the book are that there are chapters written by 10 world-class experts in their respective field including Professors Jean Louis Vincent, Daniel DeBacker, Jean Louis Teboul, Didier Payen, Jan Backer, Christian Boerma, Zolst Molnar, Maurizio Cecconi, and Thomas Schereen. We thank them for taking time out from their busy schedule and writing these chapters. They have also consented to work with young Indian intensivists to write these chapters giving an opportunity to our youth to do collaborative work with them.
There are 22 other topics by Indian experts. We thank them for their dedication, time and guidance to make this book a grand success.
The focus of the book is not merely on monitoring aspects but as the name of the workbook and our workshop goes, there is a stress on hemodynamic management.
Our long-term goal is to make this book a “Must Read” workbook for all intensive care trainees in India and Asian countries.
We once again thank to all the stalwarts in critical care for their contribution towards this book.
Hope the young readers enjoy reading it as much as we have enjoyed presenting it to you.
Sameer Jog
Kayanoosh J Kadapatti
Sunitha Binu Varghese
Acknowledgments
On behalf of the Indian Society of Critical Care Medicine (ISCCM), Pune branch, we sincerely appreciate the contribution of each and every author for timely completing their chapters. Everyone's contribution has added more credibility to this book Workbook on Hemodynamic Management.
We thank all the authors for their continued enthusiasm and dedication and look forward to doing such activities in the future.
We appreciate the contribution of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their tireless follow-up and completing the book within the time-line.
Jyoti Shendge
Chairman—ISCCM, Pune