Abstract
The goal of cardiovascular therapy is to create a physiological condition wherein blood flow and oxygen delivery to the tissues is adequate to meet the metabolic demands of the tissues without inducing untoward cardiorespiratory complications. Cardiovascular insufficiency is often referred to as circulatory shock and is often the primary manifestation of critical illness. In most clinical conditions associated with circulatory shock, the primary concerns and therapeutic options relate to three functional performance-based questions:
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Will blood flow to the body increase (or decrease) if the patient’s intravascular volume is increased (or decreased), and if so, by how much?
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Is any decreased in arterial pressure due to loss of vascular tone or merely due to inadequate blood flow?
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Is the heart capable of maintaining an effective blood flow with an acceptable perfusion pressure without going into failure?
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References
Connors AF Jr, Speroff T, Dawson NV, et al (1996) The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA 276: 889–997
Lichtwarck-Aschoff M, Zeravik J, Pfeiffer UJ (1992) Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation. Intensive Care Med 18: 137–138
Pinsky MR, Vincent JL, DeSmet JM (1991) Estimating left ventricular filling pressure during positive end-expiratory pressure in humans. Am Rev Respir Dis 143: 25–31
Magder S, Georgiadis G, Cheong T (1992) Respiratory variations in right atrial pressure predict the response to fluid challenge. J Crit Care 7: 76–85
Magder S, Lagonidis D, Erice F (2001) The use of respiratory variations in right atrial pressure to predict the cardiac output response to PEEP. J Crit Care 16: 108–114
Perel A, Pizov R, Cotev S (1987) Systolic blood pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology 67: 498–502
Szold A, Pizov R, Segal E, Pere! A (1989) The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs. Intensive Care Med 15: 368–371
Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P (1998) Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 89: 1313–1321
Denault AY, Gasior TA, Gorcsan J, Mandarino WA, Deneault LG, Pinsky MR (1999) Determinants of aortic pressure variation during positive-pressure ventilation in man. Chest 116: 176–186
Michard F, Chemla D, Richard C, et al (1999) Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med 159: 935–939
Michard F, Boussat S, Chemla D, et al (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162: 134–138
Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL (2001) Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119: 867–873
Pinsky MR (1984) Determinants of pulmonary artery flow variation during respiration. J Appl Physiol 56: 1237–1245
Pinsky MR (1984) Instantaneous venous return curves in an intact canine preparation. J Appl Physiol 56: 765–771
Sharpey-Schaffer EP (1955) Effects of Valsalva maneuver on the normal and failing circulation. Br Med J 1: 693–699
Brower R, Wise RA, Hassapoyannes C, Bromberger-Barnea B, Permutt S (1985) Effect of lung inflation on lung blood volume and pulmonary venous flow. J Appl Physiol 58: 954963
Schlichtig R, Kramer D, Pinsky MR (1991) Flow redistribution during progressive hemorrhage is a determinant of critical 02 delivery. J Appl Physiol 70: 169–178
Sunagawa K, Maughn WL, Burkhoff, Sagawa K (1983) Left ventricular interaction with arterial load studied in the isolated canine ventricle. Am J Physiol 245: H773 - H785
Wesseling K, Wit Bd, Weber J, Smith NT (1983) A simple device for the continuous measurement of cardiac output. Adv Cardiovasc Physiol 5: 16–52
Sagawa K, Suga H, Shoukas AA, Bakalar KM (1977) End-systolic pressure-volume ratio: A new index of contractility. Am J Cardiol 40: 748–756
Cariou A, Monchi M, Laurent I, et al (2001) Noninvasive estimation of left ventricular elastance during sepsis. Am J Respir Crit Care Med 163: A135 (Abst)
Mandarino W, Gorcsan J, Pinsky MR (1998) Assessment of left ventricular contractile state by preload-adjusted maximal power using echocardiographic automated border detection. J Am Coll Cardiol 31: 861–868
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Pinsky, M.R. (2002). Functional Hemodynamic Monitoring: Applied Physiology at the Bedside. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-5551-0_49
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DOI: https://doi.org/10.1007/978-1-4757-5551-0_49
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