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Physiologic chart for rapid identification of causes of abnormal haemodynamics
1CardioDynamics International Corporation, Irvine, CA 92718, USA.
Insights
This study introduces the Haemodynamic Management Chart (HMC) to precisely manage patient hemodynamics. The HMC guides clinicians to optimize Mean Arterial Pressure (MAP), Stroke Index (SI), and Cardiac Index (CI) for improved patient outcomes.
Area of Science:
- Cardiovascular Physiology
- Critical Care Medicine
- Hemodynamic Monitoring
Background:
- Systemic hemodynamics are defined by Mean Arterial Pressure (MAP) and Stroke Index (SI), influencing Cardiac Index (CI) and Oxygen Delivery Index (DO2I).
- Abnormal hemodynamic states arise from imbalances in intravascular volume, inotropy, vasoactivity, and chronotropy.
Purpose of the Study:
- To present the Haemodynamic Management Chart (HMC) as a tool for precise hemodynamic management.
- To move beyond trial-and-error approaches in managing patient hemodynamics.
Main Methods:
- Categorizing hemodynamic states based on MAP, SI, and CI levels (normal, infranormal, supranormal).
- Utilizing the HMC to identify relationships between volume, inotropy, and vasoactivity deviations.
- Determining chronotropy deviations based on Cardiac Index (CI) deviations from normal.
Main Results:
- The HMC maps 9 potential hemodynamic states and 3 Cardiac Index (CI) states.
- It elucidates the interplay of modulating pathways (volume, inotropy, vasoactivity) in abnormal hemodynamic states.
- The HMC facilitates continuous hemodynamic management aligned with the Haemodynamic Therapeutic Goal (HTG).
Conclusions:
- The HMC offers a structured approach to hemodynamic management, replacing trial-and-error methods.
- Continuous management within the Haemodynamic Therapeutic Goal (HTG) is expected to shorten therapy duration and improve patient outcomes.
Abstract:
The systemic haemodynamic state is expressed by paired values of Mean Arterial Pressure (MAP) and Stroke Index (SI), varying for every heart beat. Algebraic product of SI and Heart Rate (HR) then defines the perfusion-related Cardiac Index (CI), which is the dynamic modulator of Oxygen Delivery Index (DO2I). Since MAP, SI and CI can each attain a normal, infranormal or supranormal level, there is a total of 9 haemodynamic states, plus 3 CI states. A patient with normal haemodynamics has MAP, SI and CI within his/her normal ranges. The remaining 8 abnormal haemodynamic states and 2 abnormal CI states are the vectorial end-result of a combination of abnormal levels of haemodynamic modulating pathways, i.e., intravascular volume, inotropy, vasoactivity and chronotropy. The Haemodynamic Management Chart (HMC) identifies the inter-relationship between the deviations in volume, inotropy and vasoactivity responsible for the observed haemodynamic state in respect to the desired haemodynamic state (Haemodynamic Therapeutic Goal [HTG]). The deviation in CI from its normal level then determines the deviation in chronotropy. In contrast to current management methodology of trial and error, the HMC enables the clinician to continuously manage a patient's haemodynamics within the HTG. This is expected to produce a shorter therapy and improved outcome.