2014 monitoreo hemodinamico avanzado del paciente crítico / advanced hemodynamic monitoring in...
DESCRIPTION
A small guide about Advanced Hemodynamic Monitoring in Critical Medicine. Una pequeña guia sobre Monitoreo Hemodinámico Avanzado en el paciente crítico. Francisco J. Chacón-Lozsán, MD http://ve.linkedin.com/in/chaconlozsanfranciscoTRANSCRIPT
![Page 1: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/1.jpg)
![Page 2: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/2.jpg)
Sociedad Europea de CardiologíaHospital Central Universitario
Dr. J. M. Casal RamosUnidad de Cuidados Intensivos
Dr. Francisco J. Chacón-LozsánMédico Cirujano. UCLA-Venezuela
Residente Medicina Crítica y Cuidados IntensivosSociedad Europea de Cardiología
Mayo 2014
![Page 3: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/3.jpg)
European Society of CardiologyUniversitary HospitalDr. J. M. Casal Ramos
Intensive Care Unit
Dr. Francisco J. Chacón-LozsánMedical Doctor. UCLA-Venezuela
Critical Medicine and Intensive Care ResidentEuropean Society of Cardiology
May 2014
![Page 4: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/4.jpg)
Monitoreo HemodinámicoAvanzadodel Paciente Crítico
![Page 5: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/5.jpg)
Advanced HemodynamicMonitoringIn CriticalPatient
![Page 6: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/6.jpg)
Fis
iolo
gía/
Phy
siol
ogy
![Page 7: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/7.jpg)
Fis
iolo
gía/
Phy
siol
ogy
![Page 8: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/8.jpg)
Gasto Cardiaco
Frecuencia Cardiaca
Fis
iolo
gía/
Phy
siol
ogy
Gasto cardiaco (GC)=Frecuencia Cardiaca (Fc) x Volumen latido (VL)
![Page 9: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/9.jpg)
Cardiac Output
Heart Rate
Fis
iolo
gía/
Phy
siol
ogy
Cardiac Output (CO) = Heart rate (HR) x Stroke Volume (SV)
![Page 10: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/10.jpg)
Frecuencia Cardiaca/Heart Rate
![Page 11: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/11.jpg)
Frecuencia Cardiaca/Heart Rate
![Page 12: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/12.jpg)
Condiciones para medida de Fc
Frecuencia Cardiaca/Heart Rate
Conditions to measure HR
Paciente en condiciones confortables y temperatura adecuada.
Esperar descanso de 5min antes de realizar la medición.
Palpar el puso durante 60segundos
Patient in comfortable conditions and adequate temperature.
Wait 5min before of rest before measurement.
Palpation of pulse during 60sec.
![Page 13: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/13.jpg)
Gasto Cardiaco
Frecuencia Cardiaca
Volumen Sistólico
![Page 14: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/14.jpg)
Cardiac Output
Heart Rate
Stroke Volume
![Page 15: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/15.jpg)
Fases de los Sonidos de Korotkoff
Presión arterial
![Page 16: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/16.jpg)
Korotkoff’s sounds
Blood Pressure
![Page 17: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/17.jpg)
Presión arterial/Blood Pressure
![Page 18: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/18.jpg)
Sistema Renina Angiotensinas Aldosterona
Renine AngiotensineAldosteroneSystem
![Page 19: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/19.jpg)
Presión arterial Media/ Mean Blood PressurePAM
Depende de:
Volemia Gasto cardiacoResistencia
vascular sistémicaDistribución
Arterio-Venosa
PAM= 2PAD+PAS/3
MAP= 2DBP+SBP/3
Valores: 70-105 mmHg
![Page 20: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/20.jpg)
Presión arterial Media/ Mean Blood PressureMAP
Depends on
Volemia Cardiac OutputSystemic Vascualr
ResistanceBlood
disrtibution
PAM= 2PAD+PAS/3
MAP= 2DBP+SBP/3
Values: 70-105 mmHg
![Page 21: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/21.jpg)
Presión arterial Media/ Mean Blood Pressure
![Page 22: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/22.jpg)
![Page 23: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/23.jpg)
El Flujo de la sangre dentro del VasoBlood flow inside the vassels
Flujo de sangre= diferencia en presión sanguínea Resistencia Periférica
Presión Sanguínea= flujo de sangre x resistencia periférica
Onda de Pulso/Pulse wave
Blood Low = Blood presssure diference Vascular Resistance
Blood pressure = Blood flow x vascular resistance
![Page 24: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/24.jpg)
Resistencia Vascular Periférica/Vascular RessitanceLey de Poiseulle/Poiseulle Law
Onda de Pulso/Pulse Wave
![Page 25: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/25.jpg)
Ela
stic
idad
Art
eria
l/A
rter
ial E
last
ance
Onda de Pulso/Pulse Wave
![Page 26: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/26.jpg)
Ela
stic
idad
Art
eria
l/A
rter
ial E
last
ance
Onda de Pulso/Pulse Wave
![Page 27: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/27.jpg)
Análisis de la onda de pulso/Pulse Wave Analysis
Onda de Pulso/Pulse Wave
![Page 28: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/28.jpg)
Figure 1
Figure 1
Análisis de la onda de pulso/Pulse Wave Analysis
Onda de Pulso/Pulse Wave
![Page 29: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/29.jpg)
Figure 2
Análisis de la onda de pulso/Pulse Wave Analysis
Onda de Pulso/Pulse Wave
![Page 30: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/30.jpg)
Figure 2
Análisis de la onda de pulso/Pulse Wave Analysis
Onda de Pulso/Pulse Wave
![Page 31: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/31.jpg)
Figure 3
Figure 3
Análisis de la onda de pulso/Pulse Wave Analysis
Onda de Pulso/Pulse Wave
![Page 32: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/32.jpg)
Aórtico/Aortic
Braquial/Brachial
Onda de Pulso/Pulse Wave
![Page 33: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/33.jpg)
Relación de la onda de pulso con la fuerza de contractilidad cardiaca
![Page 34: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/34.jpg)
Pulse and cardiac contractility
![Page 35: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/35.jpg)
Presión de Pulso/Pulse Pressure
PP= PAS-PAD
PP= SBP-DBP
![Page 36: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/36.jpg)
Presión de Pulso/Pulse Pressure
Presión de Pulso => Volumen sistólico
Pulse Pressure => Stroke Volume
![Page 37: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/37.jpg)
Presión de Pulso/Pulse Pressure
![Page 38: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/38.jpg)
Presión de Pulso/Pulse Pressure
![Page 39: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/39.jpg)
Presión de Pulso/Pulse PressureEfecto del Volumen Tidal en la presión y Volumen del VI
Effect of Tidal Volume on LV pressure and volume
![Page 40: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/40.jpg)
Oximetría de Pulso/Pulse oximetry
![Page 41: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/41.jpg)
Oximetría de Pulso/Pulse oximetry
![Page 42: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/42.jpg)
Oximetría de Pulso/Pulse oximetry
Media Distribution and Standard Deviation in both groups
Groups Median SD
AG 97,61%HbO2 2,39
PO 98,13%HbO2 1,87
AG: arterial gasometryPO: Pulse Oximetry
Differential range and percent of trustiness in measurementsDiferential range 0,52
% trustiness 99,47%
![Page 43: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/43.jpg)
Oximetría de Pulso/Pulse oximetry
![Page 44: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/44.jpg)
ERROR
Oximetría de Pulso/Pulse oximetry
Ambient
Interferences
Less blood flow
Rise of the venous
pressure
Anemia
TPN
Ambiente
Interferencias
Disminución flujo
sanguíneo
Aumento presión
venosa
Anemia
NPT
![Page 45: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/45.jpg)
Volumen Sistólico/Stroke Volume1. Fracción de Eyección del VI
Volumen telediastólico-Volumen telesistólico/Volumen telediastólico x 100
2. Volumen sistólico• PP/PAS+PAD
1. LV ejection fraction(Telesystolic volume – teledyastolic volume)/Telediastolic volume * 100
2. Stoke Volume• PP/SBP+DBP
![Page 46: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/46.jpg)
Volumen Sistólico/Stroke Volume
![Page 47: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/47.jpg)
Pre-Carga/Pre-Load
![Page 48: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/48.jpg)
Pre-Carga/Pre-Load
![Page 49: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/49.jpg)
• Relación E/A• Tiempo de desaceleración de E• Relación E/E’• Tiempo de relajación isovolumétrica
E: llenado protodiastólico rápido; A: contracción auricular izquierda
Pre-Carga/Pre-Load• E/A Relation• E decreasing time• E/E’ Relation• Isovolumetric relaxation
![Page 50: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/50.jpg)
PVC VD VI CAP
Pre-Carga/Pre-Load
![Page 51: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/51.jpg)
Pre-Carga/Pre-Load
![Page 52: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/52.jpg)
Pre-Carga/Pre-Load
![Page 53: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/53.jpg)
Pre-Carga/Pre-Load
![Page 54: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/54.jpg)
Pre-Carga/Pre-Load
![Page 55: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/55.jpg)
Post-Carga/After-LoadSVR = (MAP-CVP)*80
CONormal: 800-1200din/s/cm-5
MAP: Mear Arterial PressureCVP: Central Venous Pressure in mmHgmmHg = cmH2O/1,36
![Page 56: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/56.jpg)
Contracción Ventricular
Volumen
Contractilidad/ContractilityLey de Franck Starling/Franck Starling Law
![Page 57: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/57.jpg)
Contractilidad/Contractility
A: normal ContractilityB: Raised contractilityC: Decreased contractility
![Page 58: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/58.jpg)
Índice de trabajo cardiaco Izquierdo(Gasto cardiaco/superficie corporal total )x PAM x 0,0144
Índice de trabajo cardiaco Derecho(Gasto cardiaco/superficie corporal total ) x PaPO x 0,0144
Left workload index(Cardiac output/total body surface)x MAP x 0,0144
Right workload index(Cardiac output/total body surface)x MPP x 0,0144
Contractilidad/Contractility
![Page 59: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/59.jpg)
Contractilidad/Contractility
![Page 60: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/60.jpg)
Otros Parámetros/ Others parameters
Consumo miocárdico de oxígeno (Doble producto)Contenido Arterial de oxígenoTransporte arterial de oxígenoConsumo sistémico de OxígenoÍndice de Shock
Myocardial Oxygen Consumption (Double Product)Arterial Oxygen contentArterial oxygen transportSystemic oxygen consumptionShock index
![Page 61: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/61.jpg)
Producto Frecuencia-Presión PFP (Doble Producto)Rate-Pressure Product RPP (Double Product)
DP = (PAS*Fc)/100
DP=(SBP*HR)/100
Heart rate and the rate-pressure product as determinants of cardiovascular risk in patients with hypertension. Am J Hypertens (1999) 12 (S2): 50S-55SS
We can conclude that RPP showed large circadian variability in normotennsive, hypertensive patients.SCRIPTA MEDICA (BRNO) – 73 (2): 67–75, April 2000
This study confirms the close relationship that exists between a determinant of myocardial oxygen consumption (RPP), and indices for LV wall tension, in Black-Africans with HF. Akintunde K. The significance of rate pressure product in heart failure patients. ICFJournal. 2013; 1.
![Page 62: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/62.jpg)
Thus regulation of Q˙ TOT, LBF, and arterial O2 delivery to contracting intact human skeletal muscle is dependent for signaling primarily on CaO2, not PaO2. This finding suggests that factors related to CaO2 or [Hb] may playan important role in the regulation of blood flow during exercise in humans.Am. J. Physiol. 276 (Heart Circ. Physiol.45): H438–H445, 1999
CaO2 = (Hb*1,38*SaO2)+(0,03*PaO2)
Contenido Arterial de Oxígeno Arterial Oxygen content
![Page 63: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/63.jpg)
Low perfusion increase oxygen demands and oxygen deliveryLa baja perfusión aumenta las demandas de oxígeno y por lo tanto el transporte de oxígeno.
Transporte Arterial de Oxígeno/Arterial Oxygen Transport (DaO2)Consumo sistémico de Oxígeno/Systemic oxygen consumption (VO2)
VO
2
DaO2
DaO2 GC*(Hb*1,38)*SaO2/1000 CO*(Hb*1,38)*SaO2/1000
VO2 (GC*10*Hb(SaO2-SvO2)*1,34)/100 (CO*10*Hb(SaO2-SvO2)*1,34)/100
![Page 64: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/64.jpg)
Índice de Shock/ Shock index
SI = HR/MAP
IS=Fc/PAM
![Page 65: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/65.jpg)
Fórmulas/ EquationsParámetro/Parameter Fórmula Equation
Presión de Pulso/Pulse Pressure (PP)
PP=PAS-PAS PP=SBP/DBP
Presión arterial Media (PAM) / Mean Arterial Pressure (MAP)
PAM= (2*PAD)+PAS 3
MAP= (2*DBP)+SBP 3
Índice de Shock/ Shock Index (Si)
Si= Fc/PAM Si = HR/MAP
Volumen Latido (VL)/ Stroke Volume (SV)
VL=PP/PAM SV=PP/MAP
Gasto Cardiaco (GC)/ Cardiac Output (CO)
GC=VL*Fc CO=SV*HR
Índice Cardiaco (IC)/ Cardiac Index (CI)
IC = GC/SCTSCT(Superficie Corporal Total)
CI = CO/BSABSA(Body Surface Area)
Índice de volumen sistólico (iVS)/ Stroke Volume Index (Svi)
iVS= VL/SCT Svi=SV/BSA
![Page 66: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/66.jpg)
Fórmulas/ EquationsParámetro/Parameter Fórmula Equation
Índice de Shock (IS)/ Shock Index (SI)
IS= Fc/PAM SI = HR/MAP
Doble producto (DP)/Double Product (DP)
DP= (Fc*PAS)/100 DP = (HR*SBP)/100
Contenido Arterial de Oxígeno/Arterial Oxygen content (CaO2)
(Hb*1,38*SaO2)+(0,03*PaO2) (Hb*1,38*SaO2)+(0,03*PaO2)
Transporte Arterial de Oxígeno/ Arterial Oxygen Delivery (DaO2)
GC*(Hb*1,38)*SaO2/1000 CO*(Hb*1,38)*SaO2/1000
Consumo sistémico de oxígeno/ Systemic Oxygen Consumption (VO2)
(GC*10*Hb(SaO2-SvO2)*1,34)/100 (CO*10*Hb(SaO2-SvO2)*1,34)/100
Resistencia Vascular Sistémica/ Systemic Vascular Resistance (RVS)
PAM-PVC/GC*79,9 (MAP-CVP/CO)*79,9
![Page 67: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/67.jpg)
METODOS INVASIVOSINVASIVE METHODS
• Monitoreo Intra-arterial• Presión Venosa Central (PVC)• Swan Ganz
• Intra-arterial Monitoring• Central Venous Pressure (CVP)• Swan Ganz
![Page 68: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/68.jpg)
Monitoreo Intra-arterialIntra-arterial Monitoring
Relative Indications
• Major surgery• Major Trauma• Cardiopulmonary bypass surgery• Uncontrolled/Labile blood pressure.• Inaccurate noninvasive monitor• Sepsis/shock• Pulmonary dysfunction
Indicaciones Relativas
• Cirugía Mayor• Trauma Mayor• Bypass Cardiopulmnar• Presión arterial no controlable o
lábil presión• Monitor no invasivo no exacto• Sepsis/shock• Disfunción Pulmonar
![Page 69: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/69.jpg)
Monitoreo Intra-arterialIntra-arterial Monitoring
![Page 70: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/70.jpg)
Monitoreo Intra-arterialIntra-arterial Monitoring
![Page 71: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/71.jpg)
Presión Venosa Central/Central Venous Pressure
VN/NV: 0-10 cmH2OmmHg= cmH2O/1,36
![Page 72: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/72.jpg)
Presión Venosa Central/Central Venous Pressure
Wave and phase Mechanical event
a End of Diastolec Systole beginx Half Systolev Systolic endy Diastole begin
Atrial contractionIsovolumetric contractionAtrial relaxation Atrial Systolic fuel Ventricular relaxation
![Page 73: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/73.jpg)
Cateterización Arteria Pulmonar (Swan-Ganz)Pulmonary Artery Catheterization (Swan-Ganz)
![Page 74: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/74.jpg)
Swan-Ganz
![Page 75: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/75.jpg)
Swan-Ganz
![Page 76: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/76.jpg)
Swan-Ganz
![Page 77: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/77.jpg)
![Page 78: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/78.jpg)
![Page 79: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/79.jpg)
Val
ores
nor
mal
es /
Nor
mal
Val
ues
![Page 80: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/80.jpg)
Valores normales / Normal Values
![Page 81: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/81.jpg)
Valores normales / Normal Values
![Page 82: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/82.jpg)
¿Qué hacer?/ What to do?
![Page 83: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/83.jpg)
Pinsky M, Payen D. Functional Hemodynamic Mornitoring. Springer editorial. Germmany 2005
¿Qué hacer?/ What to do?
![Page 84: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/84.jpg)
¿Qué hacer?/ What to do?
![Page 85: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/85.jpg)
¿Qué hacer?/ What to do?
![Page 86: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/86.jpg)
• Lemus y col. Cuidado Crítico cardiovascular. Sociedad Colombiana de Cardiología. 1era ed. 2010.• Gullo y col. Intensive and Critical Care Medicine. Springer-Verlag Italia 2009.• Persons y col. Secretos de los Cuidados Intensivos. 1era ed. McGraw Hill. 2000.• Apostolakos y col. The Intensive care Manual. McGraw Hill. 2001.• Headley. Monitorización Hemodinámica Invasiva, principios fisiológicos y aplicaciones clínicas. Edwards Critical Care Division. 1996.• Iazzio y col. Handbook of cardiac Anatomy, physiology and devices. Humana press edit. 2005.• Montecoucco y col. The Renin-Angiotensin SystemModulates Inflammatory Processes in Atherosclerosis: Evidence from Basic Research
and Clinical Studies. Mediators of Inflammation Volume 2009, Article ID 752406, 13 pages• Riva Rocci S. Gazz Med Torino 1896;47:981-996, 1001-1017• Korotkoff NS. Proceedings of the Emperor’s Military Medical Academy St Petersburg 1905;11:365-367.• Tomas et al. Recommendations for Blood pressure measurement in Humans and Experimental Animals. Hypertension 2005;45;142-161.• Figueroa y col. Frecuencia cardiaca y riesgo cardiovascular. Hipertens riesgo vasc. 2011;28(1):9—15• Caballero. Terapia Intensiva. Edit Ciencias Médicas. 2006• Morgan. The Oxyhemoglobin disociation curve in critical illness. Critical Care and Resuscitation 1999; 1: 93-100 • García. Oximentría de pulso Vs gasometría arterial. REVISTA ESPAÑOLA DE INVESTIGACIONES QUIRURGICAS vol XII, númer 2. 2009.• Pinsky M, Payen D. Functional Hemodynamic Mornitoring. Springer editorial. Germmany 2005.• Rady, M.Y., Smithline, H.A., et al, A comparison of the shock index and conventional vital signs to identify acute, critical illness in the Emergency
Department, Ann Emerg Med, 1994, 24(4), 685-90.
• Berger T, Green J, Horeczko T, Grag N, Suarez A et al. Shock index and early recognition of sepsis in the emergency department: Pilot study. West J Emerg Med 2013;14(2):168-174
• Liu Y, Liu J, Fang Z, Shang G, Xu J,Qi Z, e al. Modified shock index and mortality rate of emergency patients. World J Emerg Med 2012;3(2):114-117
• Kashour T. Shock index: an emerging powerful predictor of short and intermediate –term mortality in patients with acute coronary syndromeJ Am Coll Cardiol. 2014;63(12_S)
Referencias/References
![Page 87: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/87.jpg)
Y terminamos!And, Done!
![Page 88: 2014 Monitoreo Hemodinamico Avanzado del paciente crítico / Advanced Hemodynamic Monitoring in critical patient](https://reader035.vdocuments.mx/reader035/viewer/2022081720/558c76ccd8b42a716c8b45dd/html5/thumbnails/88.jpg)
Gracias…Thanks…Francisco J. Chacón-Lozsán, MD
http://ve.linkedin.com/in/chaconlozsanfrancisco