cardiac output measurement: when and...
TRANSCRIPT
![Page 1: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/1.jpg)
Cardiac Output Measurement: When and how?
Jeffrey Burns, M.D., M.P.H. Chief, Division of Critical Care Medicine
Children’s Hospital Boston Associate Professor of Anesthesia and Pediatrics
Harvard Medical School
![Page 3: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/3.jpg)
Cardiac Output Measurement: When and how?
• Why measure cardiac output, what is the endpoint we are seeking?
• Currently available minimally invasive cardiac output monitors
• ScvO2: the Canary of the body? • What about other biomarkers: lactate and B-
type natriuretic peptide (BNP)?
3 Dr. J Burns, Chillan 2009
![Page 4: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/4.jpg)
Cardiac Output Measurement: When and how?
• Why measure cardiac output, what is the endpoint we are seeking?
• Currently available minimally invasive cardiac output monitors
• ScvO2: the Canary of the body? • What about other biomarkers: lactate and B-
type natriuretic peptide (BNP)?
4 Dr. J Burns, Chillan 2009
![Page 5: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/5.jpg)
Why measure cardiac output?
Pinsky MR. Why measure cardiac output? Critical Care. 2003 Apr;7(2):114-6.
5 Dr. J Burns, Chillan 2009
![Page 6: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/6.jpg)
Cardiac Output Measurement: When and how?
• Why measure cardiac output, what is the endpoint we are seeking?
• Currently available minimally invasive cardiac output monitors
• ScvO2: the Canary of the body? • What about other biomarkers: lactate and B-
type natriuretic peptide (BNP)?
6 Dr. J Burns, Chillan 2009
![Page 7: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/7.jpg)
7 Dr. J Burns, Chillan 2009
![Page 8: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/8.jpg)
8 Dr. J Burns, Chillan 2009
![Page 9: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/9.jpg)
Funk DJ, Moretti EW, Gan TJ. Minimally invasive cardiac output monitoring in the perioperative setting.
Anesthesia & Analgesia. 2009 Mar;108(3):887-97 9 Dr. J Burns, Chillan 2009
![Page 10: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/10.jpg)
Cardiac Output Measurement: When and how?
• Why measure cardiac output, what is the endpoint we are seeking?
• Currently available minimally invasive cardiac output monitors
• ScvO2: the Canary of the body? • What about other biomarkers: lactate and B-
type natriuretic peptide (BNP)?
10 Dr. J Burns, Chillan 2009
![Page 11: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/11.jpg)
Is SvO2 the Canary of the body? • Dueck MH, Klimek M, Appenrodt S, Weigand C, Boerner U. Trends
but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions. Anesthesiology 2005; 103:249–257.
• Reinhart K, Rudolph T, Bredle DL, Hannemann L, Cain SM. Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest 1989; 95: 1216–1221.
• Lee J, Wright F, Barber R, Stanley L. Central venous oxygen saturation in shock: a study in man. Anesthesiology 1972; 36: 472–478.
• Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M. Lack of equivalence between central and mixed venous oxygen saturation. Chest 2004; 126: 1891–1896.
11 Dr. J Burns, Chillan 2009
![Page 12: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/12.jpg)
Central Venous Oxygen Saturation: the Canary of the Body?
12 Dr. J Burns, Chillan 2009
![Page 13: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/13.jpg)
ScvO2 versus SvO2?
Pinsky MR. Hemodynamic evaluation and monitoring in the ICU. Chest. 2007 Dec;132(6):2020-9.
13 Dr. J Burns, Chillan 2009
![Page 14: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/14.jpg)
A decrease in SvO2 and ScvO2 represents an increased metabolic stress, because the O2 demands of the body are
not completely met by DO2.
14 Dr. J Burns, Chillan 2009
![Page 15: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/15.jpg)
Central Venous Oxygen Saturation: the Canary of the Body?
15 Dr. J Burns, Chillan 2009
![Page 16: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/16.jpg)
Rivers, E. et al. N Engl J Med 2001;345:1368-1377 16 Dr. J Burns, Chillan 2009
![Page 17: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/17.jpg)
Rivers, E. et al. N Engl J Med 2001;345:1368-1377
17 Dr. J Burns, Chillan 2009
![Page 18: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/18.jpg)
18 Dr. J Burns, Chillan 2009
![Page 19: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/19.jpg)
19 Dr. J Burns, Chillan 2009
![Page 20: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/20.jpg)
20 Dr. J Burns, Chillan 2009
![Page 21: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/21.jpg)
21 Dr. J Burns, Chillan 2009
![Page 22: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/22.jpg)
Cardiac Output Measurement: When and how?
• Why measure cardiac output, what is the endpoint we are seeking?
• Currently available minimally invasive cardiac output monitors
• ScvO2: the Canary of the body? • What about other biomarkers: lactate and
B-type natriuretic peptide (BNP)?
22 Dr. J Burns, Chillan 2009
![Page 23: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/23.jpg)
23 Dr. J Burns, Chillan 2009
![Page 24: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/24.jpg)
24 Dr. J Burns, Chillan 2009
![Page 25: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/25.jpg)
25 Dr. J Burns, Chillan 2009
![Page 26: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/26.jpg)
26 Dr. J Burns, Chillan 2009
![Page 27: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/27.jpg)
27 Dr. J Burns, Chillan 2009
![Page 28: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/28.jpg)
28 Dr. J Burns, Chillan 2009
![Page 29: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/29.jpg)
Risk stratification in neonates and infants submitted to cardiac surgery with cardiopulmonary bypass: A multimarker approach combining inflammatory
mediators, N-terminal pro-B-type natriuretic peptide and troponin I Fabio Carmona, Paulo H. Manso, Walter V.A. Vicente, Margaret Castro, Ana P.C.P. Carlotti
• High N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels pre-operatively and high IL-8 levels or low platelet count 4 hours post operative were independent predictors of LCOS.
• In addition, high cardiac troponin I concentrations 4 hours post operative and prolonged CPB duration were independent predictors of in-hospital death.
29 Dr. J Burns, Chillan 2009
![Page 30: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/30.jpg)
Cardiac output measurement in children: What is lacking?
“Thus, what is lacking in cardiac output assessment in children? First, the new methods investigated…should undergo further validation in different real clinical situations. Second, the use of algorithms should then be applied in the management of children with shock and cardiac output measurement; this may be useful in the decision-making process and in the final outcome.”
Ronco R, Riquelme C: Cardiac output measurement in children: what is lacking? Pediatr Crit Care Med. 2008 May;9(3):333-4.
30 Dr. J Burns, Chillan 2009
![Page 31: Cardiac Output Measurement: When and how?intensivo.sochipe.cl/subidos/catalogo3/CardiacOutputMeasurementBurns... · mediators, N-terminal pro-B-type natriuretic peptide and troponin](https://reader033.vdocument.in/reader033/viewer/2022050718/5e17dd0738f60c34cf6ab6a7/html5/thumbnails/31.jpg)
Cardiac output measurement in children: What is lacking?
A good intensivst at the bedside is better than any single technology or biomarker!
Implementing the best evidence; do not forget to be a good clinician
31 Dr. J Burns, Chillan 2009