1. Copyright © 2008 Thomson Delmar Learning CHAPTER 15 Hemodynamic Measurements

2. Copyright © 2008 Thomson Delmar Learning HEMODYNAMIC MEASURMENTS DIRECTLY OBTAINED BY MEANS OF THE PULMONARY CATHETER

3. Copyright © 2008 Thomson Delmar Learning Insertion of Pulmonary Catheter Fig. 15-1. Insertion of Pulmonary Catheter.

4. Copyright © 2008 Thomson Delmar Learning Hemodynamic Values Directly Obtained by Pulmonary Artery Catheter Table 5-1

5. Copyright © 2008 Thomson Delmar Learning HEMODYNAMIC VALUES COMPUTED FROM DIRECT MEASURMENTS

6. Copyright © 2008 Thomson Delmar Learning Computed Hemodynamic Values Table 15-1

7. Copyright © 2008 Thomson Delmar Learning Stroke Volume (SV) SV is the volume of blood ejected by the ventricles with each contraction Preload, afterload, and myocardial contractility are major determinants of SV

8. Copyright © 2008 Thomson Delmar Learning Stroke Volume (SV) SV is derived by dividing the cardiac output (CO) by the heart rate

9. Copyright © 2008 Thomson Delmar Learning Stroke Volume (SV) For example, if an individual has a cardiac output of 4.5 L/min (4500 mL/min) and a heart rate of 75 beats/min, the stroke volume would be calculated as follows:

10. Copyright © 2008 Thomson Delmar Learning Factors Increasing and Decreasing SV, SVI, CO, CI, RVSWI, and LVSWI Table 15-3

11. Copyright © 2008 Thomson Delmar Learning Factors Increasing and Decreasing SV, SVI, CO, CI, RVSWI, and LVSWI Table 15-3

12. Copyright © 2008 Thomson Delmar Learning Stroke Volume Index (SVI) SVI is derived by dividing the SV by the body surface area (BSA)

13. Copyright © 2008 Thomson Delmar Learning Stroke Volume (SVI) For example, if a patient has a stroke volume of 60 mL and a body surface area of 2 m 2, the SVI would be determined as follows:

14. Copyright © 2008 Thomson Delmar Learning Stroke Volume (SVI) Assuming the heart rate remains the same, as the SVI increases or decreases, the CI also increases or decreases. The SVI reflects: 1.Contractility of the heart 2.Overall blood volume status 3.Amount of venous return See Table 15-3

15. Copyright © 2008 Thomson Delmar Learning Cardiac Index (CI) CI is calculated by dividing the CO by the body’s surface area (BSA)

16. Copyright © 2008 Thomson Delmar Learning Cardiac Index (CI) For example, if a patient has a cardiac output of 5 L/min and a body surface area of 2 m 2, the cardiac index is computed as follows: See Table 15-3 for a list of factors that increase and decrease the cardiac index

17. Copyright © 2008 Thomson Delmar Learning Right Ventricular Stroke Work Index (RVSWI) Measures amount of work required by right ventricle to pump blood Reflects the contractility of right ventricle Increases in afterload causes RVSWI to increase, until plateau is reached

18. Copyright © 2008 Thomson Delmar Learning Right Ventricular Stroke Work Index (RVSWI) Derived from the following formula:

19. Copyright © 2008 Thomson Delmar Learning Right Ventricular Stroke Work Index (RVSWI) For example, if a patient has an SVI of 35 mL, a PA of 20 mm Hg, and a CVP of 5 mm Hg, the patient’s RVSWI is calculated as follows: (next slide)

20. Copyright © 2008 Thomson Delmar Learning Right Ventricular Stroke Work Index (RVSWI)

21. Copyright © 2008 Thomson Delmar Learning Left Ventricular Stroke Work Index (LVSWI) Measures amount of work required by left ventricle to pump blood Reflects contractility of the left ventricle Increases in afterload causes the LVSWI to increase, until plateau is reached

22. Copyright © 2008 Thomson Delmar Learning Right Ventricular Stroke Work Index (RVSWI) The LVSWI is derived from the following formula:

23. Copyright © 2008 Thomson Delmar Learning Left Ventricular Stroke Work Index (LVSWI) For example, if a patient has an SVI of 30 mL, an MAP of 100 mm Hg, and a PCWP of 5 mm Hg, then:

24. Copyright © 2008 Thomson Delmar Learning Vascular Resistance As blood flows through the pulmonary and then the systemic vascular system there is resistance to flow. –Pulmonary system is a low resistance system –Systemic vascular system is a high resistance system

25. Copyright © 2008 Thomson Delmar Learning Pulmonary Vascular Resistance (PVR) PVR measurement reflects afterload of right ventricle. It is calculated by the following formula:

26. Copyright © 2008 Thomson Delmar Learning Pulmonary Vascular Resistance (PVR) For example, to determine the PVR of a patient who has a PA of 15 mm Hg, a PCWP of 5 L/min: (Next slide)

27. Copyright © 2008 Thomson Delmar Learning Pulmonary Vascular Resistance (PVR)

28. Copyright © 2008 Thomson Delmar Learning Factors that Increase Pulmonary Vascular Resistance (PVR) Table 15-4

29. Copyright © 2008 Thomson Delmar Learning Factors that Increase Pulmonary Vascular Resistance (PVR) Table 15-4

30. Copyright © 2008 Thomson Delmar Learning Factors that Decrease Pulmonary Vascular Resistance Table 15-5

31. Copyright © 2008 Thomson Delmar Learning Systemic or Peripheral Vascular Resistance (SVR) SVR measurement reflect the afterload of the left ventricle. It is calculated by the following formula:

32. Copyright © 2008 Thomson Delmar Learning Systemic or Peripheral Vascular Resistance (SVR) If a patient has an MAP of 80 mm Hg, a CVP of 5 mm Hg, and a CO of 5 L/min:

33. Copyright © 2008 Thomson Delmar Learning Factors that Increase and Decrease Systemic Vascular Resistance (SVR) Table 15-6