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Cardiovascular Support in ICU

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Presentation on theme: "Cardiovascular Support in ICU"— Presentation transcript:

1 Cardiovascular Support in ICU
Dr ben harris

2 Objectives Basic physiology (+small amount of biochemistry)
Indications for CVS support Drugs used for CVS support

3 Some basic physiology Cardiac output = ? Mean arterial pressure = ?
Stroke volume x heart rate Stroke volume? Mean arterial pressure = ? Cardiac output x systemic vascular resistance Diastolic BP + (1/3 systolic BP – diastolic BP) Oxygen Delivery Cardiac output x oxygen content (1.34 x SaO2 x Hb)

4 MAP Stroke volume Heart rate Systemic Vascular Resistance

5 MAP and CO

6 Inotropy / Chronotropy
MAP and SVR β1 Inotropy / Chronotropy β2 Vasodilation ⍺1 Vasoconstriction

7 Shock Cardiogenic Hypovolaemic Septic Anaphylactic Neurogenic

8 Shock

9 Clinical Signs of Shock
Confusion Delirium Tachycardia Hypotension ⬆ CRT Tachypnoea Cool / Clammy Warm / sweaty Oliguria Metabolic acidosis

10 Lactate

11 Anaesthesia

12 Anaesthesia

13 CVS Support Optimise circulating volume Optimise other physiology
Fluids Blood products in massive haemorrhage Optimise other physiology

14 CVS Support Non-catecholamines Ephedrine Metaraminol Phenylephrine

15 CVS Support Catecholamines

16 CVS Support Catecholamines Noradrenaline Adrenaline
Dopamine / dobutamine

17 CVS Support

18 CVS Support Vasopressin Milrinone Levosimendan

19 Summary MAP = CO x SVR 5 types of shock Peripheral vasopressors
Central Vasopressors Noradrenaline  vasopressin  adrenaline

20 References Cardiovascular failure, inotropes and vasopressors. British Journal of Hospital Medicine, May 2012, Vol 73, No 5 Basic Sciences, Update in Anaesthesia, December 2008, Vol 24, No 2 Mean Arterial Pressure,

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