<<

are a measurement of the efficiency and efficacy of the cardiovascular system to provide oxygen to the tissues • There are a number of values that can be obtained and understanding them can help manage your patient • With the evolution of technology we can obtain these values a number of ways: • with Vigileo • Central Venous • Swan Ganz Pulmonary Catheter with Vigilance II monitor

• More information can be obtained about the Vigileo and Vigilance monitors at: http://www.edwards.com/education/pages/cceducatio nmap.aspx

Parameter Normal value Causes of elevation Causes of depression

Cardiac Output (CO) 4-8 Liters/min Early , , , failure, (later), MI, shock compensation (early), valvular , , , Mechanical assist devices (CI) 2.5-4 Liters/min/m2 Same as above Same as above

Systemic (SVR) 900-1200 dynes/cm2 Vasopressors, , late , , septic shock Early Sepsis, Vasodilators

Stroke Volume (SV) 60-80 ml Increased circulating volume, Impaired contractility, valve inotropes dysfunction, , MI (EF) 55-70% NA MI, (dilated more than hypertrophic) Pressure (PAP) 20-30/5-15 mmHg Left to right cardiac shunt, PA NA , COPD, PE, pulmonary , left ventricular failure, chronic Pulmonary Artery Wedge/Occlusion 4-12 mmHg Left ventricular failure, mitral valve Hypovolemia Pressure (PAWP/PAOP), Left , MI, ventricular end diastolic pressure (LVEDP)

Central Venous Pressure/Right Atrial 2-6 mmHg Decreased venous return, Hypervolemia, right sided heart Pressure (CVP/RAP) hypovolemia failure, MI

SvO2 (Mixed Venous Oxygen 60-80% Increased CO, Decreased oxygen Decreased CO, decreased Saturation) extraction at the tissues (left shift , decreased SaO2, on oxyhemoglobin dissociation Increased oxygen consumption at curve), Decreased oxygen demand the tissues (Not providing enough

at the tissues, increased SaO2 O2), Right shift of oxyhemoglobin dissociation curve Decreased SvO2 Increased SvO2 Cardiac Type of Shock SVR PAWP SvO Treatments Output/Index 2

Normal to Normal to Revascularization, Cardiogenic Low Low high high Inotropes, IABP

High Distributive (early) (Septic, High Low Low IVF, Vasopressors Low Neurogenic) (late)

Hypovolemic High High Low Low IVF,