2. European Society for Computing and Technology in Anesthesia and Intensive Care 2010 Non-invasive pulse contour cardiac output by Nexfin technology Johannes J. van Lieshout, Wilbert A. Wesselink, Berend E. Westerhof Special Medical Care, Dpt Internal Medicine Laboratory for Clinical Cardiovascular Physiology, Center for Heart Failure Research Academic Medical Center Amsterdam

3. Casus

8. Continuous Finger Arterial Pressure From Finger Pressure to Flow Non-invasive pulse contour cardiac output - Outline

10. Clinical standard

12. 9/00 JJvL 05/06 JJvL late 1970s: Non-Invasive Blood pressure Device (NIBD)

13. 9/00 JJvL 05/06 JJvL

14. Pressure as Function of Location in Arterial Tree Nichols & O’Rourke 2005

15. Finger pressure Portapres Finometer NexFin

16. Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat Blood Pressure - Volume Clamp

17. Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff Blood Pressure - Volume Clamp

18. Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff Changes in diameter opposed by a fast pressure servo controller that changes finger cuff pressure Blood Pressure - Volume Clamp

19. Bogert LW, Van Lieshout JJ. Exp Physiol 2005;90(4):437-46 Blood Pressure - Volume Clamp l Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat l Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff l Changes in diameter opposed by a fast pressure servo controller that changes finger cuff pressure l Expert system (Physiocal  ) defines and maintains the correct diameter at which the finger artery is clamped

21. Bogert LWJ et al. Anaesthesia, 2010

26. Martina J et al. Revision

29. Continuous Finger Arterial Pressure From Finger Pressure to Flow Non-invasive pulse contour cardiac output - Outline

30. Windkessel model 1-3 The 3 element Windkessel model is used to determine the afterload (Z in ) of the heart for every beat

31. Windkessel model 2-3

32. Windkessel model 3-3

33. Nexfin CO-Trek age gender height weight Z0CwZ0Cw stroke volume cardiac output heart rate RpRp Pressure MAP Z in

35. 05/06 JJvL

36. Harms MPM, Wesseling KH, Pott F, Jenstrup M, Van Goudoever J, Secher NH, Van Lieshout JJ. Clin Sci 1999 Jellema WT, Wesseling KH, Groeneveld AB, Stoutenbeek CP, Thijs LG, Van Lieshout JJ. Anesthesiology 1999

37. Nissen P, Van Lieshout JJ, Novovic S, Bundgaard-Nielsen M, Secher NH. Liver Transplantation 2009

38. Bogert LW, Wesseling KH, Schraa O, Van Lieshout EJ, De Mol BA, Van GJ, Westerhof BE, Van Lieshout JJ. Anaesthesia 2010

39. Continuous Finger Arterial Pressure From Finger Pressure to Flow Non-invasive pulse contour cardiac output - Outline

40. Continuous Cardiac Output Tissue Perfusion & Oxygenation Perspective