Hemodynamics Management

From the advance monitoring picture showed Map 79 , BP 141/61, CO 7l/min,CI7.0, SVi 91, HR 77/min,SVV 28%, PPV 29%, VO2i 11 ( very low), SVRi is 826 dsm2/cm5. Hb , SpO2, DO2i, PSi values are missing,

SVV 28% and PVV 29% means fluid responsive are strong predictives . SVRi are low while normal value is 1900 to 2400 dynes s m2/cm5.

Conclusion: High PPV and high SVV are predictive of fluid responsive parameters while SVRi is low indicator of vasodilation ( low after load ) indicates distributive shock syndrome. Low O2 consumption value means hypothermic which is common in distributive shock while hypovolumic and cardiagenic shock should be high .

IVC is not collapsing and echo showed good contractility .

Hopefully Dr. Mazen will encourage me as this advance monitoring is not available in our institute.

A case of distributive shock, preload is adequate as shown CVP 14 , SVV is 10 % , SV , CO and CI are high , Very low SVR 411. On triple vasopressors but lactate is very high 13.

Clinical history in details is important.

I will optimise the vasopressors especially noradrenaline infusion according to SVR and UOP. I will recommend to add a small dose of dobutamine to improve tissue perfusion which will help in lowering down the lactate levels and will check lactate levels frequently to know the right path of resuscitation and management. I will do SCvO2 level and HB value . As per protocol I will treat the underlying cause as soon as possible. In case of septic shock, initiation of adequate and appropriate antibiotics will be given accordingly.

I will do liver function test , as in liver dysfunction the lactase level remains high.

I will check renal function test and close eyes 👀 on UOP.

The EV 1000 has both thermodilution + pulseconture (which require special condition)

It looks to be missing some data (it could be missing the thermodilution thermostat for the CVC?)

From the only available data:

- distributive shock

- cardiac function are already optimised (CO, CI)

- PVR still low, but systematic flow is supplied (MAP)

- Preload (we need more data, specifically setting, rhythm, breath generation, Tv), GEDV, (CVP: the volume is not depleted), EVLW