1. Haemodynamic Monitoring Theory and Practice

2. 2 Haemodynamic Monitoring A.Physiological Background B.Monitoring C.Optimising the Cardiac Output D.Measuring Preload E.Introduction to PiCCO Technology F.Practical Approach G.Fields of Application H.Limitations

3. The haemodynamic instability is identified. What can be done for the patient (sepsis example)? 1. Step: Volume Management Aim? Monitoring – what is the point? Optimisation of CO Recommendation of the SSC How can you optimise CO? Optimisation of CO 3

4. PreloadContractilityAfterload Chronotropy Frank-Starling mechanism Monitoring – what is the point? Optimisation of CO 4

5. SV Preload V V V SV Normal contractility Preload, CO and Frank-Starling Mechanism Optimisation of CO target areavolume responsivevolume overloaded 5

6. V V SV Preload Poor contractility Normal contractility target areavolume responsivevolume overloaded 6 Preload, CO and Frank-Starling Mechanism Optimisation of CO

7. V V SV Preload Preload, CO and Frank-Starling Mechanism Optimisation of CO High contractility Normal Contractility target areavolume responsivevolume overloaded Poor contractility 7

8. V V V SV Preload, CO and Frank-Starling Mechanism In order to optimise the CO you must know what the preload is! Optimisation of CO target areavolume responsivevolume overloaded 8 Preload SV

9. Summary and Key Points Optimisation of CO The goal of fluid management is the optimisation of cardiac output An increase in preload leads to an increase in cardiac output, within certain limits. This is explained by the Frank-Starling mechanism. The measurement of cardiac output does not show where the patient’s heart is located on the Frank-Starling curve. For optimisation of the CO a valid preload measurement is indispensable. 9