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Book Details
Abstract
An evidence-based guide to hemodynamic monitoring procedures and patient care, Hemodynamic Monitoring: Evolving Technologies & Clinical Practice describes invasive, non-invasive, and minimally invasive techniques in monitoring blood pressure and oxygen levels within the circulatory system. It provides a clear, illustrated discussion of the anatomy and physiology related to hemodynamics, explains the technologies involved in each measurement, and includes quick-reference tables of normal and abnormal values. Written by cardiovascular nursing expert Mary E. Lough, Hemodynamic Monitoring is a detailed, comprehensive text designed for critical care nurses and respiratory therapists.
- Case Studies in each clinical chapter include a patient scenario with assessment details, allowing you to envision real-life patient care and prepare for adverse outcomes or complications.
- Coverage of patient safety includes a discussion of important measures that will help you provide safe and effective patient-centered care.
- UNIQUE! Coverage of patient comfort includes a discussion of methods to increase patient comfort during invasive procedures.
- Clinical Reasoning Pearls provide practical advice from experts and describe how to implement a procedure or improve patient care.
- A table of Important Values and Formulas is located inside the back cover for quick and easy reference.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Hemodynamic Monitoring: Evolving Technologies and Clinical Practice | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Reviewers | xi | ||
| Preface and Acknowledgments | xv | ||
| Contents | xvii | ||
| PART 1: Fundamentals of Hemodynamic Monitoring | 1 | ||
| Chapter 1: Physiologic Principles of Hemodynamic Monitoring | 1 | ||
| Circulation of the Blood and the Birth of Hemodynamics | 1 | ||
| Cardiac Cycle | 1 | ||
| Electrocardiography | 2 | ||
| Cardiac Cycle Diagram | 2 | ||
| Cardiac Valve Movements | 4 | ||
| Pressure Volume Loops | 10 | ||
| Stroke Volume and Ejection Fraction | 12 | ||
| Stroke Volume | 12 | ||
| Ejection Fraction | 12 | ||
| Cardiac Output | 16 | ||
| Preload | 16 | ||
| Right Atrial Preload and Venous Return | 16 | ||
| Right Ventricular Preload | 18 | ||
| Left Ventricular Preload | 19 | ||
| Starlings Law of the Heart | 19 | ||
| Pressure-Volume Relationships and the Starling Curve | 19 | ||
| Afterload | 20 | ||
| Pulmonary Vascular Resistance | 20 | ||
| Systemic Vascular Resistance | 21 | ||
| Contractility | 21 | ||
| Heart Rate | 21 | ||
| Blood Circulation | 21 | ||
| Arterial Vascular Dynamics | 22 | ||
| Sympathetic Nervous System | 22 | ||
| Parasympathetic Nervous System | 22 | ||
| Alpha- and Beta-Adrenergic Receptors | 23 | ||
| Oxygen | 23 | ||
| Nitric Oxide | 24 | ||
| Venous Vascular Dynamics | 24 | ||
| Blood Vessel Pressure, Flow, and Resistance across the Vasculature | 25 | ||
| Poiseuilles Law | 26 | ||
| LaPlaces Law | 27 | ||
| Laminar and Turbulent Flow | 27 | ||
| Regulation of Blood Pressure | 27 | ||
| Arterial Baroreceptors | 28 | ||
| Stretch Receptors | 28 | ||
| Neurohormonal Regulation of Blood Volume | 28 | ||
| Renin-Angiotensin-Aldosterone System | 30 | ||
| Natriuretic Peptides | 31 | ||
| Antidiuretic Hormone (Vasopressin) | 31 | ||
| Conclusion | 31 | ||
| References | 31 | ||
| Chapter 2: Physical Assessment and Hemodynamic Monitoring | 33 | ||
| Key Physiologic Concepts | 33 | ||
| Cardiac Output | 33 | ||
| Oxygen | 35 | ||
| Hemoglobin | 35 | ||
| General Appearance | 35 | ||
| Cardiopulmonary Distress | 36 | ||
| Physical Assessment | 36 | ||
| Skin, Mucous Membranes, and Nail Beds | 37 | ||
| Arterial Pulses | 37 | ||
| Jugular Venous Pressure | 40 | ||
| Apical Impulse | 41 | ||
| Heart Sounds | 41 | ||
| Heart Murmurs | 42 | ||
| Peripheral Edema | 43 | ||
| Lung Sounds | 45 | ||
| Ascites | 48 | ||
| Hepatojugular Reflux | 48 | ||
| Measurements | 49 | ||
| Pulse Rate and Rhythm | 49 | ||
| Blood Pressure | 49 | ||
| Respiratory Rate | 50 | ||
| Oxygen Saturation | 51 | ||
| Conclusion | 52 | ||
| References | 52 | ||
| Chapter 3: Arterial Pressure Monitoring | 55 | ||
| Historical Milestones | 55 | ||
| Key Physiologic Concepts | 57 | ||
| Arterial Pressure Waveform | 58 | ||
| Pulse Wave Velocity | 60 | ||
| Arterial Pressure Wave Contour | 60 | ||
| Clinical Procedure and Technical Considerations | 61 | ||
| Arterial Catheter Site and Insertion | 62 | ||
| The Allen Test | 62 | ||
| Arterial Pressure Monitoring | 65 | ||
| Arterial Pressure Transducer and Tubing | 65 | ||
| Arterial Pressure Fundamentals | 65 | ||
| Zeroing the Transducer | 65 | ||
| Leveling the Transducer | 65 | ||
| Baseline Blood Pressure | 66 | ||
| Square Wave Test | 66 | ||
| Catheter Patency | 66 | ||
| Arterial Catheter Blood Conservation Devices | 67 | ||
| Errors to Avoid | 67 | ||
| Mobility with Arterial Catheters | 68 | ||
| Maintenance and Troubleshooting | 68 | ||
| Complications of Arterial Catheters | 69 | ||
| Infection in Arterial Catheters | 69 | ||
| Vascular Complications with Arterial Catheters | 74 | ||
| Bleeding | 76 | ||
| Targeted Arterial Pressures in Critical Illness | 76 | ||
| Sepsis | 76 | ||
| Permissive Hypotension in Trauma | 77 | ||
| Arterial Waveform Derived Variables and Volume Responsiveness | 77 | ||
| Pulse Pressure Variation | 78 | ||
| Stroke Volume Variation | 79 | ||
| Passive Leg Raise | 80 | ||
| Arterial Waveform Monitoring for Other Devices | 81 | ||
| Conclusion | 82 | ||
| References | 86 | ||
| Chapter 4: Central Venous Pressure Monitoring | 89 | ||
| Key Physiologic Concepts | 89 | ||
| Measurement of Central Venous Pressure | 90 | ||
| Central Venous Pressure Waveforms | 97 | ||
| Establishing Baseline-Normal Pressure Ranges | 101 | ||
| Assessment of Central Venous Pressure Readings | 102 | ||
| Controversies Regarding Central Venous Pressure | 103 | ||
| Troubleshooting Primary Complications of CVP Lines | 104 | ||
| Infection | 105 | ||
| Pneumothorax | 106 | ||
| Air Emboli | 106 | ||
| Conclusion | 110 | ||
| References | 111 | ||
| Chapter 5: Pulmonary Artery Pressure and Thermodilution Cardiac Output Monitoring | 115 | ||
| Historical Milestones | 115 | ||
| Key Physiologic Concepts | 117 | ||
| Cardiac Function | 117 | ||
| Clinical Procedures and Technical Considerations | 119 | ||
| Indications | 119 | ||
| Equipment | 121 | ||
| Introducer | 121 | ||
| Pulmonary Artery Catheter | 121 | ||
| Transducer | 122 | ||
| Insertion of a Pulmonary Artery Catheter | 124 | ||
| Risks | 127 | ||
| Measurement Method | 129 | ||
| Leveling the Transducer | 129 | ||
| Head of Bed Elevation | 130 | ||
| Zeroing the Transducer | 130 | ||
| Square Wave Test | 130 | ||
| Scale | 130 | ||
| Waveform Interpretation | 130 | ||
| Measuring Right Atrial Pressure or Central Venous Pressure | 131 | ||
| Measuring the Pulmonary Artery Pressure | 131 | ||
| Measuring the Pulmonary Artery Occlusion Pressure | 131 | ||
| Pulmonary Artery Waveform Analysis | 132 | ||
| Respiratory Variation | 132 | ||
| Atrial Fibrillation | 134 | ||
| Damping | 134 | ||
| Underdamping | 134 | ||
| Spontaneous Wedge | 134 | ||
| Overwedging | 135 | ||
| Inability to Wedge | 135 | ||
| Right Ventricular Waveform | 135 | ||
| Measuring Thermodilution Cardiac Output | 135 | ||
| Continuous Cardiac Output | 136 | ||
| Intermittent-Bolus Thermodilution Cardiac Output | 136 | ||
| Fick Method | 137 | ||
| Oxygen Consumption | 138 | ||
| Interpretation of Data | 140 | ||
| Normal or Expected Values | 140 | ||
| Conclusion | 143 | ||
| References | 144 | ||
| Chapter 6: Oxygenation and Acid-Base Balance Monitoring | 147 | ||
| Historical Milestones | 147 | ||
| Basics in Pulmonary Gas Exchange: External Respiration | 148 | ||
| Blood Flow | 148 | ||
| Alveolar Gas Exchange Physiology | 148 | ||
| Alveolar Gas Exchange in Disease States | 150 | ||
| Oxygen Transport and the Oxyhemoglobin Curve | 151 | ||
| Basics in Cellular Gas Exchange and Metabolism: Internal Respiration | 153 | ||
| Acid Classification | 154 | ||
| Lactate Production and Clearance | 154 | ||
| Evaluation of Pulmonary Blood Flow and Gas Exchange | 154 | ||
| Ventilation-Perfusion Ratio and the Zones of the Lung | 154 | ||
| Oxygenation Monitoring | 157 | ||
| Continuous Oxygenation Monitoring-Pulse Oximetry | 157 | ||
| Arterial Blood Gas | 162 | ||
| Bound Oxygen in Arterial Blood | 163 | ||
| Dissolved Oxygen in Arterial Blood | 163 | ||
| Methods for Evaluating the Relationship of Ventilation to Perfusion | 164 | ||
| Acute Respiratory Distress Syndrome | 164 | ||
| PaO2/FiO2 Ratio | 165 | ||
| Alveolar-Arterial Gradient | 165 | ||
| Arterial/Alveolar Ratio | 167 | ||
| Oxygenation Index | 169 | ||
| Summary of Oxygenation Measures | 170 | ||
| Ventilation Measures and Assessment of Partial Pressure of Arterial Carbon Dioxide and End-Tidal Carbon Dioxide | 171 | ||
| The Acid-Base Balance | 172 | ||
| The Physiology of pH | 173 | ||
| State of the pH | 176 | ||
| The Metabolic Acid Hydrogen Ion Correlated to the Inverse Buffer Bicarbonate Ion | 179 | ||
| Bases | 180 | ||
| Base Excess or Base Deficit (Normal Range -2 to +2, Ideal 0) | 180 | ||
| Serum Bicarbonate (Normal Range 22 to 26mEq/L, Ideal 24) | 180 | ||
| Proteins | 181 | ||
| Chloride (Cl-) | 181 | ||
| Cellular Electrolytes | 181 | ||
| Other Buffers | 181 | ||
| Lactic Acidosis | 181 | ||
| Lactate Production | 182 | ||
| Blood Lactate Levels | 182 | ||
| Conditions Associated with Increased Lactate | 183 | ||
| Identify the Cause of the pH Change | 184 | ||
| Arterial Blood Gas-Knowledge Application | 186 | ||
| Step 1: Assess the PaO2 and P/F ratio | 187 | ||
| Steps 2, 3: Assess the pH | 187 | ||
| Step 4: Assess PaCO2 and ventilation status | 187 | ||
| Step 5: Assess bicarbonate and metabolic status | 187 | ||
| Respiratory Acidosis | 189 | ||
| Acidosis Compensation | 189 | ||
| Alkalosis Compensation | 192 | ||
| Anion Gap | 193 | ||
| Hyperchloremic Acidosis | 194 | ||
| Stewart Acid-Base Classification | 196 | ||
| The Role of the Liver and Other Organs | 196 | ||
| Applying the Methods | 196 | ||
| Conclusion | 203 | ||
| References | 203 | ||
| Chapter 7: Venous Oxygen Saturation Monitoring | 205 | ||
| Physiology of Oxygen Delivery and Consumption | 205 | ||
| Gas Exchange in the Lungs | 205 | ||
| Oxygen Delivery | 206 | ||
| Venous Oxygen Content | 208 | ||
| Oxygen Consumption | 208 | ||
| Mixed Venous Oxygen Saturation | 209 | ||
| Oxygen Extraction Ratio | 213 | ||
| Imbalance between Oxygen Delivery and Oxygen Consumption | 214 | ||
| Monitoring Technical Issues in Saturation of Venous Oxygen | 217 | ||
| Calibration | 217 | ||
| Signal Quality or Light Intensity | 217 | ||
| Dysfunctional Hemoglobins | 217 | ||
| Clinical Applications of Monitoring of Saturation of Venous Oxygen | 218 | ||
| Bleeding | 218 | ||
| Pulmonary Issues | 218 | ||
| Ventricular Septum Perforation | 219 | ||
| Central Venous Oxygen Saturation | 221 | ||
| Relationships between Oxygen Delivery and Oxygen Consumption | 223 | ||
| Conclusion | 228 | ||
| References | 229 | ||
| Chapter 8: Capnography Monitoring | 231 | ||
| Respiratory Physiology | 231 | ||
| Carbon Dioxide Measurement Devices | 232 | ||
| Sidestream Capnography | 232 | ||
| Mainstream Capnography | 233 | ||
| Colorimetric Devices | 233 | ||
| Waveform Analysis | 235 | ||
| Normal Capnogram | 235 | ||
| Capnograms in Nonintubated Patients | 237 | ||
| Applications of Capnography in Clinical Practice | 240 | ||
| Clinical Application | 242 | ||
| Endotracheal Intubation | 242 | ||
| Monitoring the Integrity of the Anesthetic Apparatus or Ventilators in Critical Care Units | 242 | ||
| Indirect Monitoring of Cardiac Output | 244 | ||
| Indirect Monitoring of Carbon Dioxide Production | 244 | ||
| Nasogastric Tube Placement | 244 | ||
| Specialty Applications | 245 | ||
| Critical Care Unit | 245 | ||
| Morphology of Carbon Dioxide Waveforms | 246 | ||
| Percutaneous Dilatational Tracheostomy | 246 | ||
| Dead Space Indices | 246 | ||
| Dead Space/Tidal Volume Ratio (Vd/Vt) and Gas Exchange Variables | 246 | ||
| Single Breath Tracing | 247 | ||
| Capnography in the Post-Anesthesia Care Unit | 247 | ||
| Capnography in Out-of-Operating Room Locations | 247 | ||
| Cardiopulmonary Resuscitation | 250 | ||
| Transcutaneous Partial Pressure of Carbon Dioxide | 251 | ||
| Conclusion | 252 | ||
| References | 252 | ||
| Chapter 9: Vasoactive Medications | 255 | ||
| Adrenergic Receptors | 255 | ||
| Vasopressor Medications | 256 | ||
| Dopamine | 258 | ||
| Phenylephrine | 259 | ||
| Norepinephrine | 260 | ||
| Epinephrine | 261 | ||
| Vasopressin | 261 | ||
| Vasodilator Medications | 262 | ||
| Nitroprusside | 262 | ||
| Nitroglycerin | 263 | ||
| Hydralazine | 264 | ||
| Nicardipine | 264 | ||
| Nesiritide | 265 | ||
| Positive Inotropes | 265 | ||
| Dopamine | 266 | ||
| Isoproterenol | 266 | ||
| Inodilators | 267 | ||
| Dobutamine | 268 | ||
| Milrinone | 268 | ||
| Beta-Blockers | 268 | ||
| Metoprolol | 269 | ||
| Esmolol | 270 | ||
| Alpha-Blockers | 270 | ||
| Phentolamine | 270 | ||
| Clonidine | 270 | ||
| Combined Alpha-Beta Blockers | 271 | ||
| Labetalol | 271 | ||
| Clinical Implications | 271 | ||
| Medication Safety | 272 | ||
| Conclusion | 277 | ||
| References | 277 | ||
| PART 2: Noninvasive and Minimally Invasive Hemodynamic Monitoring | 281 | ||
| Chapter 10: Doppler Hemodynamic Monitoring | 281 | ||
| Historical Milestones | 281 | ||
| Key Physiologic Concepts | 282 | ||
| Regulation of the Circulatory System | 283 | ||
| Doppler Background | 284 | ||
| Doppler Method | 284 | ||
| Doppler Equation | 284 | ||
| Doppler Signal | 286 | ||
| Doppler Flow Profile | 286 | ||
| Doppler Flow Volume Calculations | 287 | ||
| Angle of Insonation | 288 | ||
| Doppler Parameters | 289 | ||
| Doppler Transducers | 289 | ||
| Spectral Doppler Ultrasound | 290 | ||
| Clinical Applications of Doppler Monitoring | 291 | ||
| Preload and Stroke Volume | 291 | ||
| Stroke Volume Variation | 291 | ||
| Doppler Monitoring Devices | 293 | ||
| Transcutaneous Doppler Monitoring | 293 | ||
| Transcutaneous Doppler Indications | 293 | ||
| Transcutaneous Doppler Examination | 293 | ||
| Doppler Waveform | 295 | ||
| Transcutaneous Doppler Validation | 295 | ||
| Transcutaneous Doppler Monitor Algorithms | 295 | ||
| Transcutaneous Doppler Monitor Limitations | 296 | ||
| Esophageal Doppler Monitoring | 297 | ||
| Esophageal Doppler Indications | 297 | ||
| Esophageal Doppler Examination | 297 | ||
| Esophageal Doppler Monitor Algorithms | 300 | ||
| Esophageal Doppler Limitations | 300 | ||
| Esophageal Doppler Validation | 301 | ||
| Clinician Education and Training | 301 | ||
| Future Developments | 302 | ||
| Conclusion | 303 | ||
| References | 304 | ||
| Chapter 11: Ultrasonography-Based Hemodynamic Monitoring | 307 | ||
| Image Acquisition and Interpretation of Structures in Ultrasonography | 310 | ||
| Knobology | 310 | ||
| Probe Selection | 310 | ||
| Gel | 311 | ||
| Image Optimization | 311 | ||
| Gain | 311 | ||
| Depth | 312 | ||
| Mode | 312 | ||
| Two-Dimensional (2D) Mode | 312 | ||
| Motion Mode (M-Mode) | 313 | ||
| Doppler (Spectral, Color, and Power) | 313 | ||
| Spectral Doppler | 314 | ||
| Color Doppler | 314 | ||
| Power Doppler | 315 | ||
| Care of the Ultrasound Machine | 315 | ||
| Cleaning the Ultrasound Machine | 315 | ||
| Cardiac Assessment | 316 | ||
| Ultrasound Cardiac Windows | 317 | ||
| Subcostal Window | 317 | ||
| Apical Window | 318 | ||
| Parasternal View | 319 | ||
| Fluid Volume Status Assessment | 320 | ||
| Bedside Ultrasonography Protocols for Cardiac Assessment | 324 | ||
| Pericardial Assessment and Cardiac Tamponade | 324 | ||
| Pulmonary Edema or Fluid Overload Assessment | 325 | ||
| Vascular Assessment | 332 | ||
| FAST Examination | 332 | ||
| Conclusion | 337 | ||
| References | 338 | ||
| Chapter 12: Arterial Waveform and Pressure-Based Hemodynamic Monitoring | 341 | ||
| Historical Milestones | 341 | ||
| Windkessel Models | 342 | ||
| Physiology of Arterial Pressure and Pulse Contour | 343 | ||
| Pulse Waveform Contour, Pulse Power, and Arterial Pressure | 343 | ||
| Physiologic Factors That Impact Measurement | 347 | ||
| Technologies That Require External Calibration | 350 | ||
| Technologies That Do Not Require External Calibration | 350 | ||
| From the Arterial Line to Noninvasive Finger Cuff | 350 | ||
| Limitations | 351 | ||
| Heart-Lung Interactions Affecting Arterial Pressures | 352 | ||
| Dynamic Parameters to Assess Fluid Responsiveness | 354 | ||
| Dynamic Parameters: Caveats and Potential Limitations | 356 | ||
| Functional Physiologic Challenges | 358 | ||
| Clinical Utility | 362 | ||
| Clinical Procedure and Technical Considerations | 362 | ||
| Patient Care Considerations | 363 | ||
| Conclusion | 363 | ||
| References | 365 | ||
| Chapter 13: Implantable Hemodynamic Monitoring | 371 | ||
| Historical Milestones in Internal Hemodynamic Monitoring | 371 | ||
| Heart Failure Management | 372 | ||
| Heart Failure Management Guided by Pulmonary Artery Catheter | 372 | ||
| Heart Failure Management Guided by Physical Assessment | 373 | ||
| Heart Failure Management Guided by Noninvasive Monitoring | 373 | ||
| Heart Failure Management Guided by Telemonitoring | 374 | ||
| Implantable Hemodynamic Monitoring | 374 | ||
| Evolution of Management of Heart Failure | 375 | ||
| Implantable Stand-Alone Devices | 375 | ||
| Heart Failure Management Guided by Implantable Devices | 376 | ||
| Chronicle | 376 | ||
| HeartPOD | 376 | ||
| CardioMEMS HF System | 378 | ||
| Monitoring Features of Implanted Cardiac Resynchronization Therapy-Defibrillator (CRT-D) Devices | 383 | ||
| Using Implantable Hemodynamic Monitoring | 384 | ||
| Benefits | 384 | ||
| Potential Issues | 385 | ||
| Management Considerations | 386 | ||
| Conclusion | 388 | ||
| References | 388 | ||
| PART 3: Clinical Applications of Hemodynamic Monitoring | 393 | ||
| Chapter 14: Hemodynamics of Mechanical Ventilation and Acute Respiratory Distress Syndrome | 393 | ||
| Physiologic Breathing | 393 | ||
| Venous Return | 394 | ||
| Circulating Blood Volume | 397 | ||
| Positive Pressure Ventilation | 398 | ||
| Venous Return and Positive Pressure Ventilation | 399 | ||
| Positive Pressure Ventilation and Effect on the Right Heart | 400 | ||
| Right Heart Preload | 400 | ||
| Ventilation and Perfusion Ratio | 400 | ||
| Lung Zone Pressures | 400 | ||
| Right Ventricular Afterload | 402 | ||
| Positive Pressure Ventilation and Effect on the Left Heart | 402 | ||
| Left Heart Preload | 402 | ||
| Left Ventricular Afterload | 402 | ||
| Cardiac Contractility | 404 | ||
| Heart Rate | 404 | ||
| Positive End-Expiratory Pressure | 404 | ||
| Positive End-Expiratory Pressure and Venous Return | 405 | ||
| Positive End-Expiratory Pressure and Right Heart Function | 406 | ||
| Positive End-Expiratory Pressure and Left Heart Function | 406 | ||
| Hemodynamic Alterations in Acute Respiratory Distress Syndrome | 407 | ||
| Ventilation and Acute Respiratory Distress Syndrome | 408 | ||
| Recruitment Strategies and Hemodynamic Impact | 408 | ||
| Dynamic Hyperinflation | 411 | ||
| Ventilation Mode and Hemodynamic Impact | 412 | ||
| Hemodynamic Monitoring and Mechanical Ventilation | 413 | ||
| Pressure-Based Parameters | 413 | ||
| Echocardiography | 415 | ||
| Hemodynamic Changes with Ventilator Liberation | 416 | ||
| Conclusion | 419 | ||
| References | 419 | ||
| Chapter 15: Hemodynamics of Mechanical Circulatory Support | 429 | ||
| Historical Milestones | 429 | ||
| Categories of Mechanical Circulatory Support | 430 | ||
| Short-Term Mechanical Circulatory Support Devices | 430 | ||
| Intermediate-Term Mechanical Circulatory Support Devices | 431 | ||
| Long-Term Mechanical Circulatory Support Devices | 431 | ||
| Total Artificial Heart Device | 431 | ||
| Short-Term Mechanical Circulatory Support Therapy | 432 | ||
| Intra-aortic Balloon Pump Counterpulsation Therapy | 432 | ||
| Hemodynamic and Physiologic Effects of Intra-aortic Balloon Pump Therapy | 432 | ||
| Intra-aortic Balloon Pump Inflation | 432 | ||
| Intra-aortic Balloon Pump Deflation | 432 | ||
| Indications and Contraindications of Intra-aortic Balloon Pump Therapy | 435 | ||
| Potential Complications of Intra-aortic Balloon Pump Therapy | 436 | ||
| Hemodynamic Effectiveness and Limitations in Intra-aortic Balloon Pump Therapy | 437 | ||
| Impella Ventricular Assist Device | 438 | ||
| Hemodynamic and Physiologic Effects of Impella Device Therapy | 439 | ||
| Indications and Contraindications of Impella Device Therapy | 439 | ||
| Potential Complications of Impella Device Therapy | 439 | ||
| Impaired Hemodynamic Effectiveness and Limitations of Impella Device Therapy | 440 | ||
| TandemHeart | 440 | ||
| Hemodynamic and Physiologic Effects of TandemHeart Therapy | 441 | ||
| Indications and Contraindications for the TandemHeart | 442 | ||
| Potential Complications of TandemHeart Therapy | 442 | ||
| Impaired Hemodynamic Effectiveness and Limitations of TandemHeart Therapy | 442 | ||
| CentriMag | 443 | ||
| Hemodynamic and Physiologic Effects of CentriMag Therapy | 444 | ||
| Contraindications to Use of the CentriMag Device | 444 | ||
| Potential Complications of CentriMag Therapy | 444 | ||
| Impaired Hemodynamic Effectiveness and Limitations of CentriMag Therapy | 444 | ||
| Peripheral Extracorporeal Membrane Oxygenation System | 445 | ||
| Indications and Contraindications of Extracorporeal Membrane Oxygenation Therapy | 445 | ||
| Potential Complications of Extracorporeal Membrane Oxygenation Therapy | 447 | ||
| Impaired Hemodynamic Effectiveness and Limitations of Extracorporeal Membrane Oxygenation Therapy | 447 | ||
| Intermediate-Term Mechanical Circulatory Support Therapy | 448 | ||
| Thoratec Paracorporeal Ventricular Assist Device and Abiomed AB5000 | 448 | ||
| Indications and Contraindications of Paracorporeal Devices | 451 | ||
| Potential Complications of Paracorporeal Devices | 451 | ||
| Impaired Hemodynamic Effectiveness and Limitations of Paracorporeal Devices | 452 | ||
| Long-Term Mechanical Circulatory Support Therapy | 453 | ||
| Continuous-Flow Pumps | 453 | ||
| HeartMate II | 454 | ||
| HeartMate II Controller | 456 | ||
| HeartMate II Battery Support | 456 | ||
| Pump Power Usage | 457 | ||
| HeartMate II Pulse Index | 457 | ||
| HeartWare Left Ventricular Assist System | 457 | ||
| HeartWare Pump | 457 | ||
| HeartWare Left Ventricular Assist System Percutaneous Lead and Controller | 458 | ||
| HeartWare Left Ventricular Assist System Flow Waveform | 458 | ||
| HeartWare Left Ventricular Assist System Battery | 459 | ||
| Potential Complications and Impaired Hemodynamic Effectiveness of Continuous-Flow Pumps | 459 | ||
| Right Heart Failure | 459 | ||
| Pump Thrombosis | 461 | ||
| Preload and Afterload Sensitivity | 463 | ||
| SynCardia Total Artificial Heart | 464 | ||
| SynCardia Pump | 464 | ||
| SynCardia Monitoring | 466 | ||
| Potential Complications and Impaired Hemodynamic Effectiveness | 467 | ||
| Future Direction | 470 | ||
| References | 470 | ||
| Chapter 16: Hemodynamic Management Following Cardiac Surgery | 475 | ||
| Impact of Cardiac Surgery on Hemodynamics | 475 | ||
| Postoperative Hemodynamics in Patients with Normal Ventricular Function | 478 | ||
| Hemodynamics in Systolic Dysfunction: The Volume Overloaded Ventricle | 482 | ||
| Hemodynamics in Diastolic Dysfunction: The Pressure Overloaded Ventricle | 483 | ||
| Conclusion | 490 | ||
| References | 491 | ||
| Chapter 17: Hemodynamic Management of Heart Failure and Cardiogenic Shock | 493 | ||
| Subcategories of Heart Failure | 496 | ||
| Systolic versus Diastolic | 496 | ||
| Forward Flow versus Backward Flow | 497 | ||
| Cardiogenic Shock | 497 | ||
| Signs and Symptoms of Acute Decompensated Heart Failure and Cardiogenic Shock | 498 | ||
| Physical Examination | 498 | ||
| Neurologic Signs and Symptoms | 500 | ||
| Heart and Vascular Signs and Symptoms | 500 | ||
| Kidney Signs and Symptoms | 501 | ||
| Pulmonary Signs and Symptoms | 501 | ||
| Liver and Gastrointestinal Signs and Symptoms | 502 | ||
| Integumentary Signs and Symptoms | 502 | ||
| Cardiogenic Shock | 502 | ||
| Framework for Evaluating Heart Failure | 503 | ||
| Noninvasive Assessment | 504 | ||
| Cardiac Rate and Rhythm | 504 | ||
| Noninvasive Blood Pressure Monitoring | 505 | ||
| Pulse Oximetry | 505 | ||
| Echocardiography | 505 | ||
| Chest Radiography | 506 | ||
| Invasive Hemodynamic Assessment | 506 | ||
| Intra-arterial Monitoring | 506 | ||
| Intracardiac Pressure Monitoring | 506 | ||
| Cardiac Output Measurement | 507 | ||
| Laboratory Assessment | 508 | ||
| Laboratory Signs of Heart Failure | 508 | ||
| Natriuretic Peptides | 508 | ||
| Sodium | 509 | ||
| Oxygenation | 509 | ||
| Creatinine | 510 | ||
| Laboratory Signs of Cardiogenic Shock | 511 | ||
| Treatment of Acute Decompensated Heart Failure and Cardiogenic Shock | 511 | ||
| Find and Treat the Cause of Heart Failure | 511 | ||
| Optimization of Heart Rate and Rhythm | 513 | ||
| Optimization of Preload | 513 | ||
| Reduction of Afterload | 515 | ||
| Increasing Contractility | 516 | ||
| Treatment of Cardiogenic Shock | 517 | ||
| Mechanical Circulatory Assistance | 517 | ||
| Intra-aortic Balloon Pump | 517 | ||
| Short-Term Ventricular Assist Devices | 518 | ||
| Long-Term Ventricular Assist Devices and Heart Transplantation | 519 | ||
| Conclusion | 524 | ||
| References | 525 | ||
| Chapter 18: Hemodynamics of Acute Right Heart Failure and Pulmonary Hypertension | 529 | ||
| Historical Perspective | 529 | ||
| Key Physiologic Concepts | 530 | ||
| Right Ventricular Geometry | 530 | ||
| Right Ventricular Blood Supply | 531 | ||
| Pericardium | 531 | ||
| Ventricular Interdependence | 531 | ||
| Right Ventricular Volume Overload | 531 | ||
| Right Ventricular Dilation | 532 | ||
| Right Ventricular Pressure Overload | 532 | ||
| Acute Pulmonary Embolism | 532 | ||
| Right Ventricular Hypertrophy | 533 | ||
| Right Ventricular Infarction | 533 | ||
| Right Ventricular Failure | 533 | ||
| Right Ventricular Dysfunction in Left Heart Failure | 534 | ||
| End-Stage Right Ventricular Failure and Pulmonary Hypertension | 535 | ||
| Diagnosis | 535 | ||
| Signs and Symptoms | 535 | ||
| Laboratory Tests for Right Heart Failure | 536 | ||
| Intracardiac Pressure Measurements | 536 | ||
| Right Ventricular Diagnostic Tests | 537 | ||
| Chest Radiography | 537 | ||
| Echocardiography and Doppler Imaging | 537 | ||
| Vena Cava Collapsibility | 537 | ||
| 2D Doppler Imaging | 537 | ||
| Tissue Doppler Imaging | 537 | ||
| Speckle Tracking Imaging | 538 | ||
| Three-Dimensional Echocardiography | 538 | ||
| Transesophageal Echocardiography and Doppler | 538 | ||
| Hemodynamic Values Derived from Echocardiography and Doppler | 538 | ||
| Cardiac Magnetic Resonance Imaging | 540 | ||
| Exercise Testing | 540 | ||
| Treatment of Right Heart Failure | 540 | ||
| Optimizing Right Ventricular Preload | 540 | ||
| Reducing Right Ventricular Afterload | 541 | ||
| Improving Right Ventricular Contractility | 542 | ||
| Heart Rhythm Management | 542 | ||
| Preventing Complications | 542 | ||
| Surgical Procedures | 543 | ||
| Outpatient Treatments | 544 | ||
| Connections Between Right Heart Failure and Pulmonary Hypertension | 545 | ||
| Hemodynamics of Pulmonary Hypertension | 545 | ||
| Historical Milestones | 546 | ||
| Physiologic Concepts in Pulmonary Hypertension | 548 | ||
| Group 1 Pulmonary Arterial Hypertension | 548 | ||
| Group 2 Pulmonary Hypertension | 550 | ||
| Group 3 Pulmonary Hypertension | 551 | ||
| Group 4 Chronic Thromboembolic Pulmonary Hypertension | 551 | ||
| Group 5 Pulmonary Hypertension | 551 | ||
| Diagnosis of Pulmonary Hypertension | 551 | ||
| Laboratory Tests | 551 | ||
| Radiography | 553 | ||
| Computed Tomography Angiography | 555 | ||
| Cardiac Magnetic Resonance Imaging | 555 | ||
| Right Heart Catheterization | 557 | ||
| Acute Vasoreactivity Test | 558 | ||
| Treatment of Pulmonary Hypertension | 558 | ||
| Medications in Pulmonary Hypertension | 560 | ||
| Monitoring Symptom Progression in Pulmonary Hypertension | 562 | ||
| Surgical Treatments for Pulmonary Hypertension | 562 | ||
| Patient and Caregiver Considerations | 565 | ||
| Conclusion | 566 | ||
| References | 568 | ||
| Chapter 19: Hemodynamic Management in Hypovolemia and Trauma | 571 | ||
| Epidemiology | 571 | ||
| Etiology of Traumatic Injuries | 577 | ||
| Key Physiologic Concepts | 577 | ||
| Hemorrhagic Shock | 577 | ||
| Systemic Inflammatory Response Syndrome | 578 | ||
| Trauma Resuscitation Phase | 580 | ||
| Hemodynamic Assessment Parameters | 580 | ||
| Arterial Oxygenation Assessment | 584 | ||
| Tissue Oxygen Assessment | 585 | ||
| Central Venous Pressure Assessment | 585 | ||
| Cardiac Output Assessment | 587 | ||
| Laboratory Assessments | 587 | ||
| Resuscitation Strategies to Optimize Hemodynamic Status | 589 | ||
| Permissive Hypotension | 589 | ||
| Resuscitation with Blood Products | 590 | ||
| Hemorrhage Control | 591 | ||
| Critical Care Phase | 594 | ||
| Hemodynamic Assessment Parameters | 594 | ||
| Cardiac Output Monitoring | 596 | ||
| Venous Oxygen Saturation Monitoring | 598 | ||
| Capnography Monitoring | 598 | ||
| Laboratory Assessment Parameters | 599 | ||
| Critical Care Phase Management | 600 | ||
| Fluid Management | 600 | ||
| Pharmacologic Management | 600 | ||
| Mechanical Ventilation Management | 601 | ||
| Early Mobilization | 601 | ||
| Complications of Trauma in the Critical Care Phase | 602 | ||
| Rewarming | 602 | ||
| Intra-abdominal Hypertension and Abdominal Compartment Syndrome | 602 | ||
| Sepsis | 603 | ||
| Conclusion | 605 | ||
| References | 605 | ||
| Chapter 20: Hemodynamics of Sepsis | 607 | ||
| Historical Milestones | 607 | ||
| Epidemiology of Sepsis to Septic Shock | 610 | ||
| Sepsis Pathophysiology | 611 | ||
| Sepsis Definitions | 613 | ||
| Systemic Inflammatory Response Syndrome | 613 | ||
| Sepsis | 613 | ||
| Procalcitonin | 614 | ||
| Severe Sepsis | 615 | ||
| Septic Shock | 615 | ||
| Hemodynamics of Sepsis: Variability in Oxygen Delivery, Vascular Tone, and Arterial Volume | 615 | ||
| Preload: Volume Status in Severe Sepsis and Septic Shock | 615 | ||
| Central Venous Pressure | 616 | ||
| Pulmonary Artery Catheter | 617 | ||
| Dynamic Measures of Fluid Responsiveness | 617 | ||
| Afterload and Loss of Vascular Tone | 619 | ||
| Blood Pressure Monitoring in Severe Sepsis and Septic Shock | 619 | ||
| Myocardial Depression and Decreased Contractility | 620 | ||
| Alterations in Microvascular Blood Flow Oxyhemoglobin Dissociation and Mixed Venous and Central Venous Oxygen Saturations | 621 | ||
| Lactate Monitoring in Severe Sepsis and Septic Shock | 622 | ||
| Managing the Hemodynamics of Sepsis, Severe Sepsis, and Septic Shock | 624 | ||
| Crystalloid Fluid Resuscitation in Sepsis | 624 | ||
| Vasopressor Therapy in Sepsis | 625 | ||
| Inotropic Therapy in Sepsis | 625 | ||
| Antimicrobial Therapy in Sepsis | 626 | ||
| Conclusion | 628 | ||
| References | 629 | ||
| Chapter 21: Hemodynamic and Intracranial Dynamic Monitoring in Neurocritical Care | 633 | ||
| Historical Milestones | 633 | ||
| Central Nervous System Multimodality Monitoring | 634 | ||
| Key Physiologic Concepts | 634 | ||
| Intracranial Pressure and Cerebral Perfusion Pressure | 634 | ||
| Intracranial Pressure | 634 | ||
| Cerebral Perfusion Pressure | 638 | ||
| Cerebral Blood Flow | 638 | ||
| Cerebral Ischemia | 640 | ||
| Cerebral Hyperemia | 640 | ||
| Cerebral Vasospasm | 641 | ||
| Neurogenic Pulmonary Edema | 641 | ||
| Central Nervous System Measurement Methods | 645 | ||
| Overview | 645 | ||
| Intracranial Pressure Monitoring and Cerebral Perfusion Pressure Monitoring | 646 | ||
| External Ventricular Drain | 646 | ||
| Clinical Procedure | 646 | ||
| Indications | 646 | ||
| Setup | 657 | ||
| Neurologic Baseline Before Intracranial Pressure Monitoring and Cerebrospinal Fluid Drainage | 657 | ||
| Assessment | 657 | ||
| Maintenance | 659 | ||
| Troubleshooting | 659 | ||
| Transducer-Tipped Intracranial Pressure Catheters | 661 | ||
| Clinical Procedure | 661 | ||
| Indications | 663 | ||
| Setup | 663 | ||
| Establishing a Neurologic Baseline | 664 | ||
| Assessment | 664 | ||
| Maintenance | 664 | ||
| Troubleshooting | 664 | ||
| Brain Oxygenation | 665 | ||
| Brain Tissue Oxygenation-PbtO2 Catheter | 665 | ||
| Procedure | 666 | ||
| Indications | 667 | ||
| Setup | 668 | ||
| Neurologic Baseline Prior to Insertion | 668 | ||
| Maintenance | 668 | ||
| Troubleshooting | 668 | ||
| Retrograde Jugular Bulb Catheter | 675 | ||
| Procedure | 676 | ||
| Indications | 677 | ||
| Setup | 677 | ||
| Neurologic Baseline Prior to Insertion | 677 | ||
| Assessment | 678 | ||
| Maintenance | 678 | ||
| Troubleshooting | 678 | ||
| Near-Infrared Spectroscopy | 679 | ||
| Procedure, Setup, Neurologic Baseline, and Maintenance | 680 | ||
| Indications | 680 | ||
| Assessment and Troubleshooting | 680 | ||
| Cerebral Blood Flow | 681 | ||
| Transcranial Doppler | 681 | ||
| Procedure | 682 | ||
| Indications | 684 | ||
| Setup | 685 | ||
| Neurologic Baseline | 685 | ||
| Assessment and Troubleshooting | 685 | ||
| Thermal Diffusion Flowmetry and Laser Doppler Flowmetry | 687 | ||
| Technical Considerations | 687 | ||
| Procedures | 688 | ||
| Indications | 689 | ||
| Setup, Neurologic Baseline, and Maintenance | 689 | ||
| Cerebral Microdialysis | 690 | ||
| Procedure | 691 | ||
| Indications | 691 | ||
| Setup, Neurologic Baseline, and Maintenance | 692 | ||
| Adjunctive Measurements | 693 | ||
| Temperature | 693 | ||
| End-Tidal Carbon Dioxide Monitoring | 694 | ||
| Pupillometry | 695 | ||
| Hemodynamics and Intracranial Dynamics Monitoring in Selected Neurologic Injury and Illness | 697 | ||
| Severe Traumatic Brain Injury | 697 | ||
| Aneurysmal Subarachnoid Hemorrhage | 699 | ||
| Spontaneous Intracerebral Hemorrhage | 703 | ||
| Chapter 22: Goal-Directed Hemodynamics | 713 | ||
| Heart | 713 | ||
| Volume | 713 | ||
| Vascular Tone | 714 | ||
| Goal-Directed Therapy | 714 | ||
| Historical Milestones | 715 | ||
| Shock and Oxygen Delivery | 715 | ||
| Volume Resuscitation Assessment | 718 | ||
| Oxygen Delivery and Oxyhemoglobin Dissociation | 719 | ||
| Goal-Directed Therapy and Protocols | 721 | ||
| Goal-Directed Therapy and Sepsis | 722 | ||
| Conclusion | 723 | ||
| References | 724 | ||
| Hemodynamic Equations and Normal Values | 727 | ||
| Index | 729 | ||
| Inside Back Cover | 772 |