Midterm - NONINVASIVE HEMODYNAMIC MONITORING

Question 1

There are three major types of noninvasive hemodynamic monitoring methods:

Answer 1

transesophageal echocardiography,
carbon dioxide elimination (V# CO2), and
impedance cardiography (ICG)

Question 2

_____ provides diagnosis and monitoring of many structural and functional abnormalities of the heart.

Answer 2

Transesophageal echocardiography

Question 3

(Transesophageal echocardiography) It can also be used to calculate cardiac output from measurement of blood flow velocity by recording the ____ of ultrasound.

Answer 3

Doppler shift

Question 4

The time velocity integral obtained for the blood flow in the left ventricular outflow tract (e.g., descending aorta) is multiplied by the _____ and the heart rate to yield the cardiac output.

Answer 4

cross sectional area

Question 5

This ____ technique requires a highly skilled technician to obtain accurate readings

Answer 5

Doppler

Question 6

The _______ procedure may be done at the bedside, and continuous readings are available with this procedure.

Answer 6

transesophageal echocardiography

Question 7

A ______ is placed into the esophagus (via the mouth or nose) with its distal end resting at the midthoracic level.

Answer 7

Doppler transducer probe

Question 8

The ____ is rotated until it faces the aorta and is able to pick up the aortic blood flow signal.

Answer 8

probe / Doppler transducer probe

Question 9

the cardiac output measured by this technique correlates well with the measurements using the traditional _____

Answer 9

thermodilution method

Question 10

_______ : A method using a Doppler transducer in the esophagus for an indirect measurement of the blood flow velocity in the descending aorta and the calculation of the cardiac output and other hemodynamic data.

Answer 10

transesophageal echocardiog- raphy

Question 11

_____ (VCO2) is a technology that can monitor and mea- sure cardiac output based on changes in respiratory CO2 concentration during a brief period of rebreathing.

Answer 11

Carbon dioxide elimination

Question 12

The ____ (with cardiac output option) is a cardio- pulmonary management system that incorporates different sensors to measure the flow, airway pressure, and CO2 concentration.

Answer 12

NICO2

Question 13

These measurements are used to calculate CO2 elimination.

Answer 13

flow, airway pressure, and CO2 concentration.

Question 14

A ____ partial rebreathing method is used to derive the cardiac output.

Answer 14

Fick

Question 15

The original Fick method uses the ____ (VO2) and ______ difference (C(a-v)O2) to calculate the cardiac output.

Answer 15

oxygen consumption / arterial- mixed venous oxygen content

Question 16

This method for calculating cardiac output requires the use of specialized equipment and has never been suitable in the traditional clinical setting.

Answer 16

Carbon dioxide elimination

Question 17

The NICO2 uses ___ instead of VO2

Answer 17

VCO2

Question 18

_____ from an exhaled breath sample is used instead of using mixed venous and arterial blood samples (for C(a-v)O2).

Answer 18

End-tidal CO2

Question 19

The ______ (Respironics®) can provide continuous cardiac output noninvasively via this method.

Answer 19

NICO system

Question 20

____ A technology to monitor and measure cardiac output based on changes in respiratory CO2 concentration during a period of rebreathing.

Answer 20

carbon dioxide elimination

Question 21

___ , also called thoracic electrical bioimpedance (TEB), is a major division of noninvasive technique for hemodynamic monitoring.

Answer 21

Impedance cardiography (ICG)

Question 22

___ is based on a technology originally used by NASA in the 1960s.

Answer 22

ICG / IMPEDANCE CARDIOGRAPHY

Question 23

The introduction of the microprocessor and the working knowledge of echocardiography and magnetic resonance imaging make ____ possible.

Answer 23

ICG

Question 24

____ is a noninvasive procedure to measure or trend the hemodynamic status of a patient in clinical settings ranging from critical care to outpatient care.

Answer 24

ICG

Question 25

Several noninvasive ____ devices are available and each offers different technology to measure and calculate the hemodynamic values.

Answer 25

ICG

Question 26

The_____ uses a patented signal processing technique to identify the opening and closing of the aortic valve for the precise measurement of the ventricular ejection time (VET).

Answer 26

IQ system

Question 27

Another device incorporates “ _____” to estimate the VET by using the QRS of the ECG and the raw dZ/dt (change in impedance/time) waveform

Answer 27

ensemble averaging

Question 28

A third manufacturer of ICG uses ______ and an ____ system to establish the dZ/dt.

Answer 28

digital signal processing / R-wave detection

Question 29

____ has proven to be a simple and accurate method to measure and monitor a patient’s hemodynamic status

Answer 29

ICG

Question 30

_____ : A noninvasive procedure to mea- sure or trend the hemodynamic status of a patient.

Answer 30

impedance cardiography (ICG)

Question 31

___ uses external electrodes to input a high frequency, low amplitude cur- rent and to measure changes of electrical resistance (impedance) in the thorax.

Answer 31

ICG

Question 32

In a typical setup, ___ and ____ electrodes are placed on the patient,

Answer 32

four outer / four inner

Question 33

The____ transmit a constant, low amplitude electrical current through the thorax.

Answer 33

outer electrodes

Question 34

The _____ measure the impedance (resistance) to the electrical signal according to the changing blood flow in the aorta.

Answer 34

inner electrodes

Question 35

The ___ and ___ of blood flow in the ascending aorta changes with each cardiac cycle

Answer 35

volume and velocity

Question 36

increasing volume and velocity during ___ and decreasing volume and velocity during ___.

Answer 36

systole / asystole

Question 37

Since the impedance changes reflect the blood flow in the ______, the changes in blood velocity are calculated and reported as values for different hemodynamic parameters.

Answer 37

ascending aorta

Question 38

____ uses external electrodes to input a high frequency, low amplitude cur- rent and measure changes of electrical resistance (imped- ance) in the thorax.

Answer 38

ICG

Question 39

Since the impedance changes reflect the blood flow in the ascending aorta during ___ and ___, the changes in blood velocity are calculated and reported as values for different hemodynamic parameters.

Answer 39

systole and asystole

Question 40

_____ is the most commonly used invasive technique for measuring and calculating the hemodynamic values.

Answer 40

Thermodilution

Question 41

The accuracy and reliability of this method rely on the proper (and correct) computation constant, injectate volume, injectate temperature measurement, injection technique, timing of injection, and averaging strategies

Answer 41

Thermodilution

Question 42

Since the ____ method provides hemodynamic measurements in a limited time frame, it cannot be used to monitor the dynamic nature of the cardiovascular system.

Answer 42

thermodilution

Question 43

The noninvasive nature of ____ makes it an ideal tool to monitor a patient’s hemodynamic status.

Answer 43

ICG

Question 44

Some of the measured and calculated hemodynamic parameters provided by ICG include: _______

Answer 44

cardiac output, cardiac index, stroke volume, stroke volume index, systemic vascular resistance, systemic vascular resistance index, contractility, and fluid status.

Question 45

the thermodilution method in which a ____ is required,

Answer 45

pulmonary artery catheter

Question 46

ICG cannot provide the values for ______

Answer 46

pulmonary artery pressure, pulmonary artery wedge pressure, pulmonary vascular resistance, and pulmonary vascular resistance index.

Question 47

In a study of patients with pulmonary arterial hypertension, the correlation of cardiac output determined by ICG versus the Fick method and the thermodilution method were ___ and ___, respectively

Answer 47

0.84 and 0.80

Question 48

___ is less variable and more reproducible than other invasive methods,

Answer 48

ICG

Question 49

it has shown sufficient clinical usefulness to become a standard practice in noninvasive hemodynamic evaluations

Answer 49

ICG

Question 50

While ___ is useful in many clinical situations, there are some technical reasons and conditions that may influence the use and accuracy of __

Answer 50

ICG

Question 51

They include wrong placement of electrodes; _____ (cachetic or obese); _____ (.120/min); _____

Answer 51

abnormal body structure (cachetic or obese); tachycardia (.120/min); presence of pacemaker; arrhythmias; open-heart or aorta surgery; abnormal cardiac anatomy (e.g., transpo- sitions, aneurysms); abnormal hematocrit; and pleural effusion.

Question 52

With ICG, the therapeutic effects of fluid administration and resuscitation can be assessed by monitoring the ___ and ____

Answer 52

stroke volume and cardiac output.

Question 53

____ has also been used to evaluate the hemodynamic status of critically ill patients in the inten- sive care units, surgical areas, and outpatient and emergency departments

Answer 53

ICG

Question 54

Evaluation and follow-up of patients with acute myocardial infarction is also possible with ____

Answer 54

ICG

Question 55

In subacute care, adjustment of the dosages of cardiovascular drugs can be done by monitoring the____ , ____, and ____

Answer 55

thoracic fluid status, stroke volume, and cardiac output

Question 56

Since ___ monitoring is noninvasive, it can be used in outpatients as well as patients at home.

Answer 56

ICG

Question 57

___ provides these advantages: noninvasive continuous monitoring, rapid diagnosis and assessment of cardiopulmonary status, hemodynamic response to fluids and drugs, and availability outside the critical care area.

Answer 57

ICG

Question 58

Advantages of Impedance Cardiography

Answer 58

Reduces risk associated with invasive hemodynamic monitoring procedures Provides rapid diagnosis and assessment of cardiopulmonary status Offers continuous noninvasive hemodynamic monitoring Monitors patient’s hemodynamic response to fluids and drugs Reduces use and risk associated with PA catheterization Reduces cost over invasive hemodynamic monitoring procedures Provides availability outside the hospital