Textbook of Hemodynamic Monitoring and Therapy in the Critically Ill Atul Prabhakar Kulkarni, Amol Trimbakrao Kothekar, Jigeeshu Vasistha Divatia
INDEX
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table.
A
Abdominal closure techniques, temporary 152
Abdominal Compartment Society Consensus Management Statements Recommendations 152
Abdominal compartment syndrome 147, 148, 149f, 151, 204
diagnosis of 149
Abdominal trauma, penetrating 306
Abdominal wall compliance 149
Acidosis 124
correction of 167
Acoustic energy 268
Acoustic impedance 265
Activated clotting time 242
Activated partial thromboplastin time 246
Active circulation volume 98, 98f
Acute cardiogenic shock 241
management of 241
Acute cor pulmonale 273
Acute coronary syndromes 130, 202, 241, 244
Acute deep vein thrombosis
diagnosis of 157
management of 157
Acute heart failure 129, 156
diagnosis of 128
Acute illness, phase of 201
Acute myocardial infarction 54, 170
Acute pulmonary embolus 273
Acute respiratory distress syndrome 23, 40, 44, 51, 55, 85, 99, 187, 192, 194
Acute right heart syndrome 190, 192
etiology of 192t
Adenosine
diphosphate 123
triphosphate 122, 143, 226
activation of 165
Adequate initial fluid resuscitation 212
Adrenaline 215
Adrenomedullin 131
Advanced trauma life support 297
Air 264
bronchogram 313f
Airway procedures, hostile environment for 326
Akinesia 285
Aluminum phosphide toxicity 170
Alveolar proteinosis 250
American College of Cardiology Foundation 127
American College of Chest Physicians 158
American College of Surgeons Advanced Trauma Life Support 210
American Heart Association Guidelines 127, 253
American Society of Echocardiography 285
Amplitude modulation 74
Anaerobic CO2 production 120
Anaphylaxis 164, 274
severe 251
Anemia, severe 124
Angina 291
Angiopoietin 132
Angiotensin 168, 215, 217
vasopressor mechanisms of 217f
Anomalous pulmonary venous return 192
Anteflexion 293f
Antibiotic stewardship 204
Anticoagulation management 246, 252
Antithrombin 167, 168
Antithrombotic therapy 158t
Aorta 76, 102, 287f, 292
ascending 13, 102, 279f, 287f
central 12
descending 102
root of 16f
Aortic aneurysm 235
Aortic dissection 76, 177, 235, 273, 291
Aortic injury 291
Aortic pressure 231
Aortic prosthesis 76
Aortic regurgitation 105, 235, 245
acute 273
Aortic valve 279f, 281f
closure of 13, 91
opening 91
regurgitation 95
Apical five-chamber view 283, 283f
Apical four-chamber view 282, 282f, 321
Apixaban 158
Apnea 311
Arrhythmia 88, 238, 244
leading 238f
Arterial blood gas 171
Arterial blood pressure 11, 12, 14f
factors regulating 12
maintaining 255
monitoring 17
waveform, components of normal 14
Arterial pressure 59f, 65
components of 65
monitoring, physiology of 11
waveform 5, 66f, 90, 91f
Arterial pulse 5
contour analysis 193
waveform, understanding 13
Arterial signal 95
Arterial system 13
Arterial wall, stiffness of 86
Arterial waveform analysis 97
Arterioles 142
Artery 342
Ascites 149, 191, 306
Atelectasis 311
Atrial fibrillation 291
Atrial natriuretic peptide 29, 131, 164
Atrial septal defect 245
Augmentation index 16
Australasian resuscitation in sepsis evaluation 118
Autoimmune diseases 156
Autonomic nervous system 14f
Axillary line
anterior 310f
posterior 310f
B
Balloon 231
catheter 231, 238
deflation in systole 232f, 232fc
gas leak leading 238f
inflation in diastole 232f, 232fc
pressure waveform
normal 237, 237f
variations 237
Barcode sign 314f
Basilar artery 137f
Bat sign 311f
Beats, types of 15f
Bedside limited echocardiography 327
Bernstein equation 77
Beta blockers 170
Bilateral lower extremity edema 191
Biochemical parameters 317
Bioimpedance 73
Bioreactance cardiac output measurement 73
Bioreactance systems 74
Biventricular function 273
Bladder pressure, measurement of 150f
Bland-Altman analysis 92
Bleeding 292
complications 252
Blood
cells 102
concentration of 98
conductivity of 102
diseases 156
ejection of 73, 74
lactate measurement 117
pressure 11
changes 238f
components of 12
different components of 12f
measurement 3
normal 11
transfusion 228
vessels 4, 98
monitoring function of 131
volume 76
amount of 101
central 98
Blue protocol 313, 314fc
Blunt abdominal trauma 306
Body buffer systems 123
Body mass index 149
Body surface area 54
Bone 264
Bradyarrhythmias 170
Bradycardia 238, 291
effects of 238f
Brain, circulation of 136
Breath, shortness of 191
Bronchospasm 291
C
Calcium 167
channel blockers 170
chloride, bolus administration of 167
sensitizers 223
Calibrated pulse contour analysis 58
Cancer 124
Cannulations
technique 340, 342
ultrasound-assisted 339
ultrasound-guided 339
Capillary endothelial barrier function 203
Capillary leak
index 209
presence of 147
Capillary perfusion 228
Capillary refill time 109, 110, 115
Carbon dioxide 70, 231, 249
partial pressure of 317
Carbon monoxide poisoning 124, 164
Cardiac anesthesiologists 290
Cardiac arrest 164, 219, 243, 291
Cardiac biomarkers 185
Cardiac competence, restoration of 202
Cardiac contractility 101, 104
Cardiac cycle
efficiency 92, 95
length of 16
Cardiac dysfunction, primary 224
Cardiac echocardiography 271
Cardiac evaluation 327
Cardiac failure 61, 97, 119, 219
congenital 95, 211
Cardiac function
assessment of 322
curve 19
index 59, 67
signs of abnormal 170
Cardiac index 54, 78, 115
Cardiac life support, advanced 326
Cardiac myosin activators 224
Cardiac output 14f, 34, 43, 54, 65, 69, 73, 78, 79, 83, 85, 86, 88, 90, 92, 94, 97, 99, 104, 119, 120, 149
calculation 322
measurement 49, 57, 58, 67, 69, 85, 90, 97, 98f, 101
monitoring 98, 101
technology for 98
Cardiac preload
assessment of 58
parameters of 104
Cardiac resynchronization 188
Cardiac surgery 119, 229
Cardiac tamponade 170, 175, 288, 320
Cardiac upstroke 91
Cardiac windows 278f
Cardio-abdominal-renal syndrome 211
Cardiocirculatory system 91
Cardiogenic shock 164, 169, 210, 219, 223, 224, 235, 241, 244, 271, 273, 274
hemodynamic management of 169
management of 171
pathway 171fc
rule out 315
Cardiopulmonary arrest 317
Cardiopulmonary bypass 94, 164
Cardiopulmonary resuscitation 219, 325
Cardiovascular collapse, sudden 191
Cardiovascular pressures 4
normal 53t
Cardiovascular system 14f, 29, 65, 118, 211
Carotid artery 340f
measurement of 324f
velocity time integral 324
Catecholamines 223, 273
Catheter 53
tip 342f
transducer system 95
Cellular hypoxia 115
Cellular oxygen, failure of 271
Cellular utilization, failure of 271
Central catheter, peripherally inserted 339
Central nervous system 211
Central venous catheter 99
Central venous oximetry 118
Central venous oxygen saturation 119, 135, 141
measure 118
Central venous pressure 4, 18, 20, 26, 27, 28f, 29, 32, 36, 40, 54, 59f, 90, 172, 192, 203, 208, 245, 272, 318, 319, 319t
measuring 19, 31, 118
monitoring of 52
physiology of 18
Central venous tracing, normal 19f
Cerebral
artery
anterior 137f
middle 137f, 138f
posterior 137f
blood flow 136
circulation 136
Cerebrovascular accident, risk of 203
Chest
radiograph 171
trauma, penetrating 306
Chronic heart failure 227
hospital management of 129
Chronic obstructive pulmonary disease 105, 314
Chronic thromboembolic pulmonary hypertension 194
Circle of Willis 137f
Circulation, complex view of 27fc
Circulatory shock 69
Circulatory system 26
simplified overview of 26fc
Circumferential pericardial effusion 304f
Cirrhosis 149
Cold peripheries 88
Colloids 204, 204t, 213
oncotic pressure 209
use of 210
Colonic pseudo-obstruction 149
Color flow
Doppler 284
imaging 268, 269
Comet tail artifact 267f
Computed tomography 171
pulmonary angiography 176, 193
Conservative late fluid management 212
Continuous cardiac output 73
measurement 54
Continuous wave Doppler 268, 269, 284
Contrast echocardiography 341
Conventional ventilation, refractory to 250
Convert electrical energy 265
Coronary artery
bypass grafting 171, 172
disease 75, 291
Coronary perfusion pressure 173
Coronary reperfusion 172
Counterpulsation, principles of 232
Coupling system 6
Cricothyroid membrane, identification of 326
Crystalloids 204, 204t, 206
fluid challenge 117
trials comparing 207t
Cumulative fluid balance 202
Curvilinear low-frequency probe 310f
Curvilinear transducer 298f
Cutaneous circulation 135
Cyanide poisoning 164
Cyclic adenosine monophosphate 226
Cyclic guanosine monophosphate 164
releasing 164
Cytotoxic shock 271
D
Dabigatran 158
Daily fluid balance 202
Damage control laparotomy 149
D-dimer 131
Deep vein thrombosis 155, 158
cause of 155
diagnosis 156
incidence and risk factors 156
prophylaxis and treatment 157
risk factors for 156t
signs of 191
Dextran solutions 206
Diaphragm, identification of 298
Diastolic augmentation 237f
Diastolic blood pressure 7, 12, 173
Diastolic dysfunction 181, 183, 184, 184f, 186188
diagnosis of 182
management of 187
new guidelines 185
pathophysiology 181
practical application of 186
progressive 183
Diastolic function, normal 183
Dicrotic limb 16
Dicrotic notch 91
Dicrotic pressure 91, 92
Differential transit time ultrasound technology 97
Digoxin 170, 226
Distributive shock 274, 315
D-lactate 124
Dobutamine 225, 229
Dopamine 166, 215, 216
Doppler
basic principles of 283
imaging, basic physics of 263
ultrasound
image 268, 333f
types of 268
Downstream arterial vessels 91
Duplex scanning 268, 269
Dynamic needle tip positioning 335
Dyssynchronous motion 323
E
Early balloon
deflation 237f
inflation 236, 236f
Early goal directed therapy 117
Echocardiography 171, 271, 317, 324
assessment 245
basic cardiac anatomy for 276
cardiopulmonary resuscitation 325
guided resuscitation 317
advantages of 326
limitations of 326
utility of 271
Echo-guided life support 327
Echo-guided needle aspiration 288
Edoxaban 158
Ejection fraction 323
heart failure 127
measurement of 323
Electrical cardiometry 101, 104, 105
parameter 104
principle of 102
Electrocardiogram 75, 243
Electrocardiography 86, 192
Elevated intravascular volume, signs of 170
Emergency airway management 326
End organ hypoperfusion 169
End-diastolic pressure 18
End-diastolic volume 14f
End-expiratory occlusion 40
test 36, 37, 40, 41f, 203
End-inspiratory occlusion 42
Endocardial viability ratio 232
Endocarditis 291
Endocrine disorders 170
End-organ damage 211t
Endothelial dysfunction 325
Endothelial glycocalyx 131
Endotracheal tube
dislodgement 292
placement, confirmation of 344
End-stage renal disease 205
Enlarged tender liver 191
Enzymatic amperometry 125
technique 125
Enzyme lactate dehydrogenase 122
Epigastric discomfort 191
Epinephrine 166, 215, 225
Esophageal rupture 291, 292
Estimated continuous cardiac output 86, 86f
device 85
European Society of Cardiology 157, 172
Heart Failure Guidelines 169
Extra-alveolar vessel collapse 195
Extracorporeal cardiopulmonary resuscitation 249, 253
rationale for 253
Extracorporeal cardiovascular support 249
Extracorporeal life support 249
organization registry 173
systems, major components of 173
Extracorporeal membrane oxygenation 105, 171, 173, 195, 231, 245, 249, 251, 291, 345
circuit, basic 250f
complications 252
types of 249
venoarterial 242f
veno-venous 249, 250
ventilation strategy for 252
weaning of 254
Extracorporeal membrane oxygenator 251
advantages of 242
circuit 249
disadvantages of 242
Extravascular lung water 58, 61, 209, 211, 212
Eyeballing 327
method 279
F
Fascial closure, abdominal 152
Fast flush test 9f
Fast negative
stable 307
unstable 307
Fast positive
stable 307
unstable 307
Fat 264
Femoral arteries 13
Femoral vein 343f
Femoral vessels 344f
cannulation of 342
Fibrinolytic therapy 172
Fick's partial rebreathing method, differential 69
Fick's principle 69, 70f
Fluid accumulation 202
Fluid administration 43, 213
stages of 208
Fluid and catheters treatment trial 55
Fluid balance 202
Fluid bolus 202
Fluid challenge 35, 202
Fluid management 62
Fluid overload 202
pathophysiologic effects of 211t
Fluid responsiveness 22, 43, 45, 62, 149, 324
methods for assessing 35t
prediction of 32, 324
tests, use of 43
Fluid resuscitation, phases of 204
Fluid status 101
Fluid stewardship 213
Fluid therapy 201, 202, 209, 210
Four Ds of 204
maintenance 202
Focal fat 268
Focused assessment with sonography 307
in trauma 297, 299, 303, 327
algorithm 307, 307fc
scan 297
Focused echocardiographic evaluation
in life support 327
in resuscitation 327
Focused rapid echocardiographic examination 327
Food and Drug Administration 205
Four air bubbles 267
Four skin sensor, total of 102
Fourier series 5f
Frank-Starling
curves 34f, 202
principle 34
Fraunhofer zone 266f
Free fluid collection 302f
Fresnel zone 266f
Functional hemodynamic monitoring 17
Functional residual capacity 149f
G
Galectin 130
Gallop rhythm 191
Gas leak 238
Gastric
bypass surgery 124
tonometry 138
Gastrointestinal endoscopy, upper 138
Gastrointestinal system 211
Gastroschisis 148
Global ejection fraction 59
Global end-diastolic volume 58, 59
Global longitudinal peak strain 323
Glomerular filtration rate 211
Glucocorticoids 167
Glucose-6-phosphate dehydrogenase 124
Glycolysis 122f
Glycosides, cardiac 224
Goal-directed fluid management 208
Goal-directed therapy 228
Graft failure, primary 251
Gravidarum 124
Green light emitting diodes 144
Growth differentiation factor 130, 132
H
Hand-held vital microscopes 145
Hartmann's solution 207
Head and neck surgery 71
Heart 98, 327
anatomy of 277f
and blood vessels 290
apex of 278f
chambers 75
complex congenital 290
compression 175
disease 131
congenital 291
failing 231
failure 101, 127, 130, 181, 227, 229
acute decompensated 227
advanced 124
biomarkers in 128t
congenital 291
risk stratification of 129
therapy 129
function
assessment of right-sided 276
monitoring 127
lung interaction 25, 28, 31, 32, 36
determinants of 27
physiology of 27
rate 16, 54, 59f, 86, 224
transplantation 173
valve 267
Helium gas 231
Hemodialysis 98
Hemodilution 211
resulting 114
Hemodynamic assessment 291
Hemodynamic coherence 114, 142
loss of 142, 143f
Hemodynamic data, acquisition of 10
Hemodynamic instability 318
Hemodynamic monitoring 62, 90
deals 127
several techniques of 57
stone of 135
system, testing of 8
tool 67
Hemodynamic parameters 75, 104t
Hemolysis 247
Hemoperitoneum 149, 300f, 317
presence of 298
Hemorrhagic shock 164
Hemothorax 300f
Heparin, unfractionated 157, 158
Hepatic blood flow 139
monitoring 139
Hepatic injury, congestive 171
Hepatic system 211
Hepatosplenomegaly 191
Heterogeneous perfusion 114
High sampling rate 267
Higher frequency linear transducer probes 332
High-sensitivity troponin 130
Human albumin 206
Hydroxocobalamin 167
Hydroxyethyl starch 204
Hypercapnia 194
Hyperchloremia, risk of 206
Hyperlactatemia 123, 124
causes of 123
develops 123
types of 123
Hypertension 238, 291
chronic 163
pulmonary arterial 192
Hyperthyroidism 192
Hypertrophy, cardiac 217
Hypervolemia 202
Hypoadrenalism, acute 274
Hypokinesia 285
Hypopharynx 292
Hypotension 255
causes of 97
context of predicting 255
development of 255, 257f
prediction models 255
problem 255
prolonged 256
risk of 210
warning of impending 258
Hypothyroidism, severe 170
Hypoventilation state 192
Hypovolemia 40, 202, 272
Hypovolemic shock 124, 210, 271
rule out 315
Hypoxia, severe 124
Hypoxic lactic acidosis 164
Hypoxic pulmonary vasoconstriction 195
I
Iliac arteries 13
Impella 243
Incoherent resuscitation, classification of 115t
Indocyanine green 140
plasma clearance 140
Indocyanine plasma disappearance rate 140
Indocyanine retention rate 140
Infection 247
Infectious Diseases Society of America 340
Infective endocarditis, diagnosis of 291
Inferior vena cava 37, 44, 148, 149f, 272, 294, 318, 318f, 319, 319f, 320
diameter 318
measurement of 318
measurements 319, 320
respiratory variation of 318
Injury, acute ischemic 171
Inotropes 171, 223, 224, 225t
classification 223
effects of 223
Inotropic agents 201
Inspiratory fall, absence of 32
Integrated hemodynamic management plan 320t
Intensive care
medicine 271
unit 77, 79, 99, 190, 205, 255, 291, 326, 342
Intermittent positive pressure ventilation 203
Internal carotid artery 137f
Internal counter pulsation, type of 231
Internal jugular vein 156, 339, 340f, 341, 346
anatomic considerations 339
guidewire in 332f
Internal mammary artery 289
International surviving sepsis campaign 118
Interstitial edema 345f
Interventricular septal motion 286f
Interventricular septum 182, 281f
Intra-abdominal contents 149
Intra-abdominal hypertension 147, 151, 203
incidence of 148
management of 151
pathophysiology of 148
Intra-abdominal infection 149
Intra-abdominal pressure 30, 147, 148, 150, 151
measurement of 150, 151
monitoring 147
Intra-abdominal tumors 149
Intra-alveolar vessels 30
Intra-aortic balloon counterpulsation system 231
Intra-aortic balloon pump 169, 171, 172, 231, 235, 236t, 291
blood pressure waveform, triggering of 234f
catheter 232t
evidence for 234
normal 233f
removal of 236
support, weaning from 236
therapy, hemodynamic consequences of 234
use, indications of 234
waveforms, abnormal 236
Intracellular cyclic adenosine monophosphate 194
Intracranial pressure 136, 149
Intragastric pressure, measuring 150
Intraluminal pressure 318
Intrathoracic blood volume 73
Intrathoracic pressure 25, 27, 28, 45
effects of 27, 28
Intrathoracic thermal volume 61
Intrathoracic volume, assessment of 60f
Intravascular pressure 19, 30
Intravascular water 212
Intravenous fluids 171
Intrinsic hepatic function 139
Invasive arterial pressure 172
Invasive blood pressure 86, 87
Invasive pressure measurements 5f
Ischemia, acute myocardial 273
Isolated diastolic dysfunction 186
K
Kidney 264
circulation in 140
disease, chronic 156
injury 171, 256
acute 171, 203, 205, 207
Kissing papillary muscle sign 323, 327
Kissing sign 272
Krebs cycle 122f
Kubicek equation 77
Kussmaul sign 31
L
Lactate 117, 125
clearance 125
measurement, use of 125
monitoring 122
Lactic acidosis 123, 124, 164
Laryngospasm 291
Laser Doppler images 111f
Late balloon deflation 237, 237f
Late balloon inflation 237, 237f
Late conservative fluid management 209
Late goal-directed fluid removal 203, 210
Lateral wall puncture 334
Left atrial 185
pressure 18, 21, 185
size and volume 182
Left atrium 193, 243, 277f, 279f, 281f-283f, 287f, 292, 294
Left main bronchus 233
Left upper quadrant
ultrasound image of 301f
view 298, 300f, 301f
Left ventricle 21, 27, 29, 30f, 62, 137f, 191, 191f, 192, 193, 277f, 279f-283f, 287f, 292
cavity 281
contraction of 11
end diastolic volume of 26, 27
Left ventricular 170, 182, 185
assist device 172, 173, 235, 241, 242, 245
assessment for 244
postoperative care of 246
contraction 11
diastolic dysfunction 186
grading of 185t
ejection fraction 273
ejection time 102, 103f
end-diastolic area 286f
advantages 321
evidence 321
interpretation of measurement 321
limitations 321
physiology 321
techniques of measurement 321
end-diastolic dimension 192, 193
end-diastolic, measurement of 318, 321f
failure 231
function, assessment of 285
outflow tract 170
calculation of 284f
measurement of 322f
obstruction 273
velocity time integral 320
preload 320
stroke work index 54
systolic function 273
estimation of 59
Levosimendan 194, 225, 228
Limon probe 140f
Linear high-frequency probe 310f
Lithium dilution 97
Livanova 243
Liver
circulation, qassess 139
disease 124
dysfunction 149, 247
failure 164
Low albumin 211
Low minute ventilation 71
Low molecular weight heparin 157, 158
Low protein levels 211
Lung 98, 305f
disease, severe 71
examination of 310
failure, acute 250
permeability 61, 62
protective strategy 195
pulse 304
sliding 310
absence of 304
sonography 327
transplantation 195
ultrasonography, integration of 289
ultrasound 309
blue protocol 309
equipment 309
falls protocol 309
using rapid 313
volume 28
M
Macrocirculation 115
Macrohemodynamic parameters 145
Main pulmonary artery, enlargement of 192
Massive hemoptysis 251
Massive hemothorax
leading 305f
presence of 304
Massive pulmonary embolism 192, 202
Massive transfusion 149
Mean arterial
blood pressure 12
pressure 7, 14f, 35, 54, 65, 115, 118, 148, 165, 172, 203, 208, 209, 215, 245
Mean transit time 60f
Mechanical circulatory support 171, 172, 195, 241
temporary 172
treated with 247
Mechanical ventilation 36, 45, 53, 149
strategies 194
weaning from 62
Mechanical vibration 263
Metabolism
inborn errors of 123, 124
normal lactate 122
products of 124
Metformin 124
toxicity 164
Methylene blue 167
Microcirculation 115
assessment of 143
monitoring of 142
Microcirculatory alterations
mechanisms of 113f
types of 143
Microcirculatory flow index 144
Microcirculatory impairment, adequacy of 135
Microcirculatory technology, advance of 143
Microconvex probe 337f
Microvascular flow index 115
Mid-regional pro-adrenomedullin 131
Mid-regional proatrial natriuretic peptide 131
Milrinone 194, 225
Mirror image artefact 267, 268f
Mitral annulus dimensions 245
Mitral leaflet, anterior 274
Mitral regurgitation 234, 273
severe 170, 273, 323
Mitral valve 192, 279f, 281f
annulus 184
inflow 182
normal 183f
level 280
Mixed venous oximetry 119
Mobile console 231
Modern ultrasonography machines 323
Monitoring system, components of 5f
Morrison's pouch 298, 327
Mottling score 111
Multiorgan
dysfunction syndrome 208
failure 203
Multiple biomarkers 127
Multiple sinusoids 5f
Muscle 264
Myocardial infarction 156, 170, 192, 273, 317
Myocardial injury 256
Myocardial ischemia 273
Myocardial oxygen supply 236
Myocardial perfusion 194
Myocardial wall thickness 76
Myocarditis 244
Myocardium, action on 224
N
Nasogastric tube 150
Natriuretic peptides 128, 186
Near infrared spectroscopy 136, 136f, 144
Needle
guides 336
visualization of 336
Neostigmine 152
Neurogenic shock 274
Neurological complications 252
Neutrophil gelatinase-associated lipocalin 171, 209
New York Heart Association 130, 245
Nicotinamide adenine dinucleotide 122
Nitric oxide 164
action of 164
inhibitors 167
synthase 167
synthesis of 165
Non-calibrated techniques 66
Noninvasive blood pressure 86, 87
Noninvasive cardiac output 70
device 70
Noninvasive dynamic index 324
Non-ST-elevation myocardial infarction 234
Noradrenaline 216
Norepinephrine 164, 166, 195, 215, 216, 220
Nucleoside reverse-transcriptase inhibitors 124
O
Obesity 149
Obstructive shock 175, 202, 211, 271, 273
category of 273
epidemiology 175
hemodynamic management of 175
imaging 176
management 176
pathophysiology 175
presentation 176
rule out 315
Oliguria 112
Omecamtiv mecarbil 226
Omphalocele 148
Open abdomen
closure of 152
management of 153
Ophthalmic artery 137f
Optimizing organ perfusion 135
Oral preparations 194
Organ perfusion, optimization of 141
Organomegaly 191
Outflow obstruction 170
Out-of-hospital cardiac arrest scenario 172
Ovarian hyperstimulation syndrome 306
Overdamped waveform 7f
causes of 7t
Oxidative phosphorylation 122, 122f, 124
Oxygen
consumption 119
delivery
failure of 271
reduced 124
transport 143
functional shunting of 143
parameters 54t
warning sign of 120
Oxygenation, extracorporeal 249
P
Pacemaker placement 291
Palliative care 173
Pancreatitis, acute 149
Papillary muscle 273, 281, 285
Paradoxically cardiac output 271
Parasternal apical short-axis view 281
Parasternal mid-papillary short axis 279, 280f
Parasternal short-axis 280f
apex view 282f
base view 281f
mitral valve view 281f
view 279
Parietal pericardium 303
Passive leg raising 38, 40, 203, 287
test 40, 42, 43f, 320
Peak aortic blood flow 101
Peak systolic pressure 15
Pediatric population 105
Pediatric-specific consensus 148
Pelvic fracture 306
Pelvis
female 302f
male 302f
Percutaneous coronary intervention 171, 172
Percutaneous drainage 152
Percutaneous tracheostomy 345
Percutaneous ventricular assist device 243
Perfused vessels
percentage of 144
proportion of 115
Perfusion status, monitoring 132
Pericardiai tamponade 304f
Pericardial disease 170, 192
Pericardial effusion 273, 287, 287f, 288f, 304f, 323
grading size of 287
Pericardial pressure 25
Pericardial tamponade 273, 315f
Pericardiocentesis 288, 289f, 344
Pericarditis, constrictive 170, 192
Pericardium 327
Peripheral artery 90
Peripheral circulation 12
Peripheral perfusion
index 111, 115
monitoring 112t
Peripheral pulse-oximetry 86
Peripheral tissues 26
Peripheral vascular disease, severe 235
Peripheral vessel resistance 91
Perisplenic collection 306
Peristaltic-like motion 195
Peritoneal dialysis 149, 306
Peritonitis 149
Phenylephrine 166, 215, 217
Pheochromocytoma 124
Phillip-Marik curves 202
Phlebostatic point 4f
Phosphodiesterase
enzyme 226
inhibitors 172, 194, 223
Physiological aspects, understanding 31
Piezoelectric crystals 265
Plasma
disappearance rate 140
increased ratio of 152
lactate, measurement of 125
Plasmalyte 206
Plateau duration 238f
Plateau leading, loss of 238f
Plethysmographic waveform 37
Plethysmography 73
Pleura 327
Pleural effusion 273, 287, 288f, 312, 313
tapping of 344
Pleural syndrome 314
Pleurectomy 311
Pleurisy 311
Pleurodesis 311
Pneumothorax 298, 304, 305f, 311, 313
post-procedure complications 341
simple 274
Point-of-care ultrasound 309, 327
Polymorphic ventricular tachycardia 170
Poor electrode skin contact 105
Poor lymphatic drainage 211
Positive end-expiratory pressure 21, 28f, 36, 53, 83, 194
application of 212
Positive fluid balance 149
association of 212
Positive-pressure ventilation 29fc, 31, 32
Post-cannulation ultrasonography 341
Postcardiac surgery 244
Post-cardiothoracic surgery 192
Postcardiotomy shock 251
Posterior wall injury 346f
Postpartum cardiomyopathy 244
Postpneumonectomy 53
Pouch of Douglas 300
Predict fluid responsiveness 36
Pre-ejection period 86
Pregnancy 306
Pressure curve, systolic portion of 91f
Pressure pulmonary edema, negative 31
Pressure recording analytical method 90, 92, 94
advantages of 90
basic principle of 91
disadvantages of 91
Pressure ulcer 211
Pressure volume loops 191f
Pressure wave, systolic portion of 91
Probe and vessel, relationship of 335f, 337f, 339f
Probe manipulation 276
Probe selection 276, 297
Procalcitonin 131
Prone ventilation, refractory to 250
Prostacyclin derivatives 194
Prosthetic valves 291
Protek Solo transseptal cannula in situ 244f
Pseudonormal pattern 183f
Pulmonary acceleration time 273
Pulmonary arterial
hypertension, severe 194
pressure 53, 245
Pulmonary artery 52, 277f, 292
catheter 20f, 51, 52, 52f, 54, 57, 78, 79, 83, 87, 90, 97, 99, 101
catheterization 53t
complications of 53
parts of 52
diastolic pressure 21, 52
occlusion 21f, 51, 53f
occlusion pressure 4, 18, 20, 21t, 22, 23, 32, 36, 52, 245, 272
waveform 21
pressure 21
mean 54
systolic pressure 286, 287f
Pulmonary capillary
pressure 22, 23, 23f
wedge pressure 52, 54, 318
Pulmonary circulation 29, 175
Pulmonary edema 97, 291, 313
management of 32
weaning-induced 45
Pulmonary embolism 61, 155, 158, 251, 317
severe 175
Pulmonary endarterectomy 195
Pulmonary hemorrhage 251
Pulmonary hypertension 71, 83, 247
Pulmonary interstitium 23
Pulmonary trauma 251
Pulmonary trunk 273
Pulmonary valve 281f
stenosis 192
Pulmonary vascular
permeability index 61, 209
resistance 26, 29, 31, 54, 245
Pulmonary vasodilators 193, 195
Pulmonary venous pressure 53
Pulmonary vessels 224
Pulse contour
cardiac output 78, 79, 83
methods 90
Pulse dye densitometry 97
Pulse oximeter 42
Pulse pressure 12, 32, 65, 86, 92
variation 30, 36, 40, 92, 272, 320, 324
Pulse wave 182
Doppler 182, 268, 284
transit time 8587
principles of 86f
validation of 87
velocity 16, 85
Pulseless electrical activity 164
Pulses paradoxus 31
Pulsus paradoxus
development of 31t
reverse 31
Pump 327
flow 252
Pumpless lung assist devices 195
Pyruvate
dehydrogenase inhibition 124
interconversion of 122
Pythagorean theorem 333, 334f
Q
Quad sign 312, 312f
Q-wave pattern 192
R
Radial artery
cannulation 343
ultrasound images of 344f
Raised jugular venous pressure 191
Randomized controlled trial 205
Real-time ultrasonography 338
guided cannulation 346
use of 346
Red blood cell 114, 142
Reflectance spectrophotometry 138
Reflected wave phenomenon 13
Reflection
amount of 265
angle of 265
Refraction 265
amount of 265
Refractory distress syndrome, severe acute 250
Refractory hypotension 164
Refractory obstructive shock secondary 177
Refractory vasodilatory shock 166
evaluation of 166
Regional lactate production 124
Regional wall motion abnormality 285, 323
Regurgitation, acute valvular 170
Renal clearance, measurement of 140
Renal dysfunction 247
Renal leak index 209
Renal microcirculation, visualization of 141
Renal perfusion 141
Renal replacement therapy 45, 167, 172, 205
Renal system 211
Respiratory distress syndrome 211
Respiratory failure 203
causes of 316
management of 309
Respiratory system 26, 211
Respiratory variation 318, 319t, 320, 324
validation 324
Resuscitation 202, 317
Retroflexion 293f
Retroperitoneal tumors 149
Revascularization 172
Reverberation artifact 267
Right atrial pressure 19, 22, 26, 286
Right atrium 52, 193, 277f, 279f, 281f-283f, 292, 294, 342f
collapse 303
Right heart
catheterization 192, 193
chambers 273
contraction 273
Right upper quadrant 298, 299f
Right ventricle 27, 29, 30, 30f, 191, 191f, 192, 193, 277f, 280f-282f, 283, 283f, 287f, 292
failure 324
Right ventricular
assist device 195, 242
collapse 304f
diastolic function 268
dilation 61
dysfunction 63, 192, 247
end-diastolic
area 286f
dimension 192, 193
volume 22, 192
failure 85, 170, 190, 203, 320
acute 273
function, assessment of 285
inflow tract 281f
myocardial infarct 192
outflow tract 192
stroke work index 54, 245
systolic dysfunction 190
Ring-down artifact 267
Ringer's lactate 205207
solution 207
Rivaroxaban 158
S
Salicylates, cyanide 124
Sarcoplasmic reticulum 226
modulation of 224
Scanning modes 266
Scanning sequence 327
Screening marker 125
Seashore sign 311f
Segmental wall function, assessment of 285
Seizures 124
Seldinger technique 6
Seminal vesicles 300
Sepsis 117, 119, 124, 143, 164, 186, 203, 273
management 118, 186
severe 110f
shock 228
uncontrolled 235
Septal abnormalities 291
Septal kinetics 286
Septic cardiomyopathy 274
Septic myocardial depression 228
Septic shock 43, 110f, 117, 119, 149, 203, 204, 218, 228, 271, 274, 323
diagnosis of 125
state of 121
terlipressin in 219
trial 166
vasopressin in 219
Serotonin syndrome 167
Serum lactate 135
Severe trauma, resuscitation of 205
Shock 109, 138, 163, 201, 208, 271, 317, 327
biomarkers in 127
causes of 271, 273
evaluation of 291
life-threatening 317
pathophysiological mechanisms of 201
pathophysiology of 201
cardiogenic 170, 170fc
resuscitation in 318
scanning 327
severe 57
treatment of 166, 271
types of 210
ultrasound with 271
Sine wave 263
Sinus arrhythmias 28
Sinusoidal sign 312, 313f
Skin
circulation in 135
examination of 109
Slow-Pressor response 217
Soft tissue 264
Sound
transmission of 265
velocity of 264t
Splanchnic circulation 137
Splanchnic ischemia 203
Spontaneous breathing 53
trial 45
Spontaneous respiration 319
Spot electrodes 76
Square wave test 8
Stabilization phase 209
Standard deviation 94
Standard thermodilution methods 105
Static tissue 343
Static ultrasonography 340
ST-elevation myocardial infarction 234
Stewart-Hamilton equation 98
Stramek equation 77
Stramek-Bernstein equation 77
Stratosphere sign 304, 314f
Strenuous severe exercise 123
Stress ulcer 172
Stressed circulatory volume 25
Stroke volume 26, 32, 34, 35, 66f, 67, 77, 8587, 9092, 104, 149, 202, 284f, 322
ejection of 26
index 54
measurement of 102, 276, 284, 285, 322
variability 193
variation 30, 36, 40, 65, 104, 320, 324
Subclavian artery 343f
Subclavian vein 343f
cannulation 341
Subcostal inferior vena cava 283, 283f
Subcutaneous emphysema 345, 345f
ultrasound image of 345f
Sublingual capnometry 139
Sublingual microcirculation 145
Subxiphoid four-chamber view 283f
Subxiphoid view 303, 304f
Superior vena cava 37, 44, 272, 277f, 291, 294, 320
collapsibility 321
diameter and respiratory variation 320
region 57
techniques of measurement 321
Supraphysiological plasma concentrations 207
Supraventricular tachycardia 291
Surgery, abdominal 149
Surgical decompression 152
Surviving sepsis campaign guidelines 204
Swan-Ganz pulmonary artery catheter 20
Systemic diseases 156
Systemic filling pressure, mean 2527, 28f, 29
Systemic inflammatory response syndrome 170
Systemic vascular resistance 11, 54, 92, 104, 215, 245
Systemic vessels 224
Systolic anterior motion 274
Systolic blood pressure 6, 7, 12, 32, 52, 92, 169
augmentation 16f
variation 30, 92
Systolic upstroke 15
T
Tachyarrhythmias 170
Tachycardia 28, 238
effects of 238f
Takotsubo syndrome 273
Tamponade
echocardiographic signs of 288f
physiology 287
four signs of 288f
Tandem heart 243
TandemHeart kit component 244f
Tension pneumothorax 273
Terlipressin 215, 218
Tetrahedron 267
Therapeutic dilemma 40
Thermal effects 269
Thermodilution 87, 94, 97
based methods 87
cardiac output 67
curve 60f
Thiamine 167, 168
deficiency 124
repletion 168
Thoracic bioimpedance 73, 83, 101
advantages of 74
basic principles of 73
cardiography 78
correlation of 78t
device 75, 75t
technology
description of 75
disadvantages of 105
Thoracic bioreactance 73, 80
advantages 80
basic principles of 73
comparison of 81t
evidence 80
limitations 80
Thoracic blood vessels 75
Thoracic cavity 76
Thoracic electrical bioimpedance 73, 79, 101
Thoracic fluid content 74
total 102
Thoracic impedance 76, 102
Thorax 102
Thrombocytopenia, heparin-induced 158
Thrombolysis 202
Thrombomodulin, soluble 131
Thrombophilia 155
Tidal volume challenge 36, 37
Time gain compensation 266, 266f
Tissue
Doppler imaging 184, 268, 269
edema 211
hypoxia 40, 113f, 124, 164
oxygenation 123
perfusion 65, 142
trauma 229
Tissue-like sign 313, 313f
Titration 202
Torsades de pointes 170
Total end-diastolic volume 98, 98f
Total vessel density 144
Toxic alcohols 124
Toxins 273
Traditional bioimpedance 104
systems 74
Transcranial Doppler 136, 137f, 138f
Transducer functions 8
Transducer manipulation 292
Transducer position 279
Transesophageal echocardiographic assessment, advanced 295
Transesophageal echocardiography 193, 233, 290292, 292f, 296
Transesophageal images, basic 295f
Transient hypotension 291
Transmitting ultrasound energy 266
Transmural pressure 25
Transpulmonary pressures 36
Transpulmonary thermodilution 57, 59f, 67
Transthoracic echocardiogram 193
Transthoracic echocardiography 253, 276, 278, 290, 291
Trauma 119, 291
abdominal 297
bedside echocardiographic assessment in 327
undefined hypotension in 306
Tricuspid annular plane 192
systolic excursion 193, 273
Tricuspid regurgitation 185, 185f, 190, 273, 287f
systolic murmur of 191
Tricuspid valve 281f
regurgitation 192
Trigger 233
Trigonometric sine waveform 74
Troponins, cardiac 129
Tuberculosis 303
Tumors, cardiac 291
Two-dimensional echocardiography 182
U
Ulrasonography 212
Ultrasonographic instruments 263
Ultrasonography 261, 303f, 326
basic physics of 263
limitations of 345
machine, imaging capability of 332
use of 346
Ultrasonography-guided
procedures 330, 332
guided procedures 330
vascular cannulations 334
Ultrasound artifacts 267
Ultrasound beam
and needle 333f
characteristics 267
Ultrasound dilution
technique 97, 98f, 99
understanding 97
use of 98
technology 98, 99
principle of 98
Ultrasound during emergencies, use of 327
Ultrasound guidance 331
Ultrasound interstitial syndrome 312
Ultrasound transducer 290
Ultrasound wave 263
attenuation of 264f
propagates 263
Ultrasound-guided
cannulation, procedure for 338
procedure 332
Uremia 303
Urinary albumin 211
Urinary bladder 300
Urinary output 147
Urine
albumin 209, 211
output 112
V
Valvular heart disease 291
severe 244
Vascular cannulation 344
relies, technique of 330
ultrasonography in 331
Vascular complications 242, 247, 252
Vascular hypertrophy 217
Vascular resistance 195
Vascular smooth muscle 164, 164f, 165
cell 165f, 166
Vascular tone, control of 164, 165f
Vasoactive agent, majority of 218
Vasoconstriction 88
mechanism of 164f
pathway 164
Vasodilatory shock 163, 168
etiology of 163, 164t
management of 166
pathophysiology of 164
rescue therapy for 167t
treatment of 219
Vasomotor tone, major 62
Vasopressin 166, 215, 217
deficiency of 165
receptors 166
Vasopressor 171, 215, 220
agents 215t
role of 194
use of excess 143
Vasorelaxation, mechanism of 164
Vein 76, 342
Velocity time integral 284f
respiratory variation of 324
Venoarterial carbon dioxide tension 118
difference 118, 120
Veno-pulmonary artery 249, 251
Venous oxygen saturation 118
Venous return
and ventricular function 27
curve 19f
physiology of 26
Venous thromboembolism 155, 156, 158, 158t
prevention of 172
process of 155
Venous thrombus 331f
Ventilation 76, 202
Ventral hernias, development of 153
Ventricles, preload of 27
Ventricular arrhythmias 191
Ventricular assist device 171, 231, 242, 243
decompresses 242
indications for 244
Ventricular dysfunction 273
primary 170
Ventricular end-diastolic volume 272
Ventricular free wall rupture 177
Ventricular interdependence 25, 29, 30, 30f, 32, 190
Ventricular septal rupture 170
Ventricular stroke volume 12
Ventricular tachycardia 291
Vertebral artery 137
Vigorous exercise 124
Vitamin
C 167, 168
deficiency 168
D deficiency 167
K antagonists 158
Volvulus 149
von Willebrand syndrome 252
W
Water 264
Wave reflection, phenomenon of 15f
Waves decay 264
Weaning 186
Weaning-induced pulmonary edema, management of 33
Wheatstone bridge principle 8
White blood cells 124
Windkessel effect 13
World Society of Abdominal Compartment Syndrome 147
×
Chapter Notes

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Textbook of Hemodynamic Monitoring and Therapy in the Critically Ill
Textbook of Hemodynamic Monitoring and Therapy in the Critically Ill
Editors Atul Prabhakar Kulkarni MD FISCCM PGDHHM Professor and Head Division of Critical Care Tata Memorial Hospital Homi Bhabha National Institute Mumbai, Maharashtra, India Editor-in-Chief, Indian Journal of Critical Care Medicine Past-President, Indian Society of Critical Care Medicine Past-Chancellor, Indian College of Critical Care Medicine Past-President, Association of SAARC Critical Care Societies Secretary General, Asia Pacific Association of Critical Care Medicine Amol Trimbakrao Kothekar MD IDCC Associate Professor Intensive Care Medicine Department of Anesthesia, Critical Care and Pain Tata Memorial Center Mumbai, Maharashtra, India Jigeeshu Vasistha Divatia MD FICCM FCCM Professor and Head Department of Anesthesia, Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai, Maharashtra, India Editor-in-Chief, Indian Journal of Anesthesia Past-President, Indian Society of Critical Care Medicine Past-Chancellor, Indian College of Critical Care Medicine
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Textbook of Hemodynamic Monitoring and Therapy in the Critically Ill
First Edition: 2020
9789389188875
Printed at
Those who toil hard, shift followed by shift, anonymously,
the reason behind our critically ill patients’ survival
The Critical Care Medicine Residents
Contributors Preface
[(True/complete) knowledge gives discipline, from discipline comes worthiness, from worthiness one gets wealth, from wealth (one does) good deeds, from that (comes) joy]
It is a joyous occasion for our team from the Department of Anesthesia, Critical Care and Pain, at Tata Memorial Hospital, Mumbai. This year's workshop plus CME, the famed Tutorials in Hemodynamic Monitoring and Therapy in Critical Care (THEMATICC 2019), is 15th in the series of CMEs, we have held annually starting in 2005. As such, this seemed an appropriate occasion to bring out the Textbook of Hemodynamic Monitoring and Therapy in the Critically Ill. The Department of Anesthesia, Critical Care and Pain, at Tata Memorial Hospital, Mumbai, has a strong tradition of publishing books which are of great use, in particular to the students of the subject; and the experienced practitioners in general, as well. The previous books, Objective Anesthesia Review published for the Anesthesiology postgraduate students, which is in the 4th edition (and we are about to come out with the 5th edition soon), and Case-based Review in Critical Care Medicine for the students of Critical Care Medicine, have proved to be immensely popular.
We hope that the current book Textbook of Hemodynamic Monitoring and Therapy in the Critically Ill will prove to be equally successful. It will be useful to all for understanding the intricacies of the bewildering array of monitors available today. We also hope that it will make their task of managing critically ill patients suffering from complex illnesses easier, and will improve their patient outcomes.
The topics in this book have been authored by experts in their own field of monitoring, from India and abroad. We hope their experience and application of their knowledge in writing these chapters will lend an authentic aura to the discussion.
Finally the core ICU team from the department has poured their sweat and blood in the making of this book, we would like to believe that the effort proves its worth, by pleasing the only critics that matter to us, you, the readers.
We wish you a pleasant reading.
Atul Prabhakar Kulkarni
Amol Trimbakrao Kothekar
Jigeeshu Vasistha Divatia
Acknowledgments
We wish to acknowledge the help of all the authors for their valuable time devoted to making contributions to this textbook, since this book would not have been possible without their hard work.
We are especially thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy), and Ms Prerna Bajaj (Development Editor) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving a go-ahead at the very beginning and helping us in every way possible to bring out this book.