Hemodynamic Monitoring and Goals

Question 1

Dobutamine vs milrinone

Answer 1

Both serve as positive inotropes to increase cardiac output

However, in the setting of kidney dysfunction, dobutamine is preferred, since milrinone has primarily renal clearance.

Question 2

Escalation of pressure management in septic shock

Answer 2

• First, 500 mL fluid bolus (mostly diagnostic to differentiate septic from hypovolemic – won’t affect pressures much in septic shock)
• Then, norepinephrine
• If norepinephrine is insufficient, a positive inotrope (dobutamine or milrinone) is the next step

Question 3

Measures of tissue perfusion

Answer 3

Urine output

MAP > 65 mmHg

Question 4

CVP functions as a measure of ___.

PCWP functions as a measure of ___.

Answer 4

CVP functions as a measure of systemic volumes.

PCWP functions as a measure of pulmonary volumes.

Question 5

Venous O2 sat goal

Answer 5

Generally >70%

Measured by blood sampled from central venous line.

Question 6

Normal SvO2

Answer 6

Ranges from 70-75%

Question 7

Blood lactate greater than ___ indicates hypoperfusion

Answer 7

Blood lactate greater than 2 mmol/L indicates hypoperfusion

It can also indicate activated glycolysis, deficient PDH activity, or liver failure.

Question 8

End-tidal CO2

Answer 8

Now routinely monitored during surgery (capnometry)

Used to evaluate PaCO2 almost continuously without a blood gas

Question 9

Intrabladder pressure

Answer 9

Used to evaluate for compartment syndrome

Intrabladder pressure > 20 mm Hg suggests abdominal compartment syndrome.

Question 10

Esophageal pressure

Answer 10

Used to approximate pleural pressures