Functional Hemodynamic Monitoring (eBook)

Michael R. Pinsky, MD is a professor of Critical Care medicine, Bioengineering and Anaesthesiology at the University of Pittsburgh and Dr hc from the University of Paris (La Sorbonne). He is considered an expert in hemodynamic monitoring, cardiovascular and pulmonary physiology and the treatments of cardio-respiratory diseases, including septic shock, ARDS and transplantation. Didier Payen, MD is a professor and chairman of Anaesthesiology and Critical Care Medicine at Laribosiere Hospital, Paris and the president of the European Society of Intensive care Medicine. He is considered an expert in hemodynamic monitoring, organ transplantation, nitric oxide metabolism and treatment and cardiovascular physiology.

Contents 5
List of Contributors 8
Common Abbreviations 12
Introduction 13
Functional Hemodynamic Monitoring: 14
Foundations and Future 14
Therapeutic goals 18
Defining Hemodynamic Instability 19
Determinants of Blood Flow and Organ Perfusion 28
Determining Effectiveness of Regional Perfusion 42
Microcirculatory and Mitochondrial Distress Syndrome (MMDS): A New Look at Sepsis 56
‘Adequate’ Hemodynamics: A Question of Time? 77
Limits and Applications of Hemodynamic Monitoring 95
Arterial Pressure: A Personal View 96
Central Venous Pressure: Uses and Limitations 105
Pulmonary Artery Occlusion Pressure: Measurement, Significance, and Clinical Uses 117
Cardiac Output by Thermodilution and Arterial Pulse Contour Techniques 141
Clinical Value of Intrathoracic Volumes from Transpulmonary Indicator Dilution 159
Methodology and Value of Assessing Extravascular Lung Water 170
Arterial Pulse Contour Analysis: Applicability to Clinical Routine 179
Arterial Pulse Power Analysis: 187
Arterial Pulse Power Analysis: The LiDCO plus System 187
Esophageal Doppler monitoring 197
Splanchnic Blood Flow 209
Measurement of Oxygen Derived Variables and Cardiac Performance 225
Microcirculatory Blood Flow: Videomicroscopy 226
Mixed Venous Oxygen Saturation (SvO2) 236
Central Venous Oxygen Saturation (ScvO2) 244
DO2/VO2 relationships 254
Cardiac Preload Evaluation Using Echocardiographic Techniques 262
Right Ventricular End-Diastolic Volume 272
Assessment of Fluid Responsiveness 285
Fluid Therapy of Tissue Hypoperfusion 286
The Use of Central Venous Pressure in Critically Ill Patients 300
Arterial Pressure Variation during Positive-pressure Ventilation 313
Arterial Pulse Pressure Variation During Positive Pressure Ventilation and Passive Leg Raising 330
Development of Treatment Algorithms 343
Standardization of Care by Defining Endpoints of Resuscitation 344
Protocolized Cardiovascular Management Based on Ventricular-arterial Coupling 377
Cost Effectiveness of Monitoring Techniques 392
Subject Index 409