Hemodynamics indications CC Flashcards
Direct arterial pressure monitoring indications
- Continuous BP measurement, need for beat-to-beat BP monitoring
- Need for frequent ABG determinations or blood sampling
- When noninvasive BP monitoring is not reliable or possible
Contraindications to direct arterial pressure monitoring
- Infection at the cannulation site
- Lack of collateral flow
Central venous pressure (CVP) indications
- Measurement of CVP
- Surrogate marker for cardiac preload
Pulmonary artery catheter indications
- Differentiation of types of shock
- Assessment of pulmonary edema (ARDS vs. cardiogenic)
- Diagnosis & monitoring of pulmonary HTN
- Diagnosis of valvular disease, intracardiac shunts, cardiac tamponade, PE
- Assessment of hemodynamic response to therapies especially in instances when other conventional therapeutic endpoints are not feasible or reliable (e.g., lack of UOP in a patient with renal failure)
- Monitoring & management for patients with heart failure or significant cardiac dysfunction
Contraindications to pulmonary artery catheter
- Coagulopathy
- Prosthetic right heart valves
- Endocardial pacemaker/defibrillator (relative contraindication)
- Left bundle branch block (may precipitate complete heart block)
- Right-sided endocarditis
- Poorly controlled dysrhythmias
- RV thrombus
Pulse wave analysis (LiDCO; LiDCO Ltd, Cambridge, UK) indications
- Principal indication is stroke volume optimization in the perioperative setting
Central venous catheter placement indications
- Venous access in patient with severe vascular disease
- Rapid volume resuscitation
- Central venous pressure monitoring
- Swan Ganz catheter placement
- Administration of vasoactive agents or caustic chemotherapy drugs
- Parental nutrition
Contraindications to central venous catheter CVC placement
- Vascular anomaly
- Infection at the site of catheter insertion
- Coagulopathy (more for subclavian placement as compression is not possible)
Limitations of PPV and SVV
- Spontaneously breathing patients
- Low tidal volumes (< 8 ml/kg)
- Arrhythmias
- ?Intra-abdominal hypertension
- RV failure/ pulmonary hypertension
- Need arterial catheter
Limitations of IVC variation/collapsibility
- Low tidal volumes
- ?Intra-abdominal hypertension
- RV failure/ pulmonary hypertension
- Technical challenges of US
Indications for target MAP>80mmHg
- High ICP
- SAH (after securing the aneurysm with delayed ischemia)
Pulmonary artery catheter insertion
- Complex hemodynamic management scenarios where noninvasive methods of cardiac output assessment are inadequate (e.g., shock states, cardiac tamponade) [Conditional Recommendation]
- Diagnosis and management of pulmonary arterial hypertension, including vasodilator testing [Conditional Recommendation]
- Perioperative management in high-risk surgical procedures when non-invasive monitoring would be inadequate [Conditional Recommendation]
Routine use of the PAC in critically ill patients is not recommended
Absolute contraindications to pulmonary artery catheter insertion
- Lack of suitable vascular access
- Presence of a right-sided ventricular assist device (VAD)
Relatve contraindications to pulmonary artery catheter insertion
- Left bundle branch block
- Severe coagulopathy
- Ventricular septal defect (VSD) or atrial septal defect (ASD)
- Significant tricuspid regurgitation
- Presence of right ventricular pacing hardware
- Pulmonary stenosis
Strongly recommended indications for thoracic, vascular, and cardiac ultrasound in the intensive care unit
Thoracic Ultrasound:
- Diagnosis of pleural effusion,
- Diagnosis of pneumothorax
Vascular Ultrasound:
- Diagnosis of lower extremity proximal DVT,
- Internal jugular and femoral vein central line placement
Echocardiography:
- Undifferentiated hemodynamic instability,
- Measurement of IVC collapsibility in mechanically ventilated patients to assess volume responsiveness,
- Assessment of LV systolic function,
- Assessment of RV function,
- Evaluation for wall-motion abnormalities after ROSC in ventricular fibrillation arrest,
- Evaluation of patients with suspected acute coronary syndrome,
- Diagnosis and treatment of pericardial effusion and cardiac tamponade,
- New murmurs,
- Hemodynamically stable patients with penetrating chest trauma
