hemodaynamic monitoring wedge pressure and central venous pressure · 2017-10-27 · hemodynamic...
TRANSCRIPT
Hemodynamic Monitoring:
Wedge pressure and Central venous pressuredo,J":'''' <V <V,
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~WUll'h111~1Ilmlivuliull~lJ\111~(~llllU"~~1f) Pocock G, Richard CD. The heart and•
circulation. In: Human Physiology: The Basis of Medicine. 3rd ed. Oxford: Oxford Univcrsity;
2006:262-308.)
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tI • II , •
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(~"mhH~lfl Pocock G, Richard CD. The heart and circulation. In: Human Physiology: The
Basis of Medicine. 3rd ed. Oxford: Oxford University; 2006:262-308.)
iI ....4:o<::I. I •••• cvCi\ .••• oltv;];]!J'If~'IJNIlVlUf1111~fl11'IJmllll111!;]l1U~1Jll (Variability factors of pressure measurement)
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mVllUfl111U measured pressure (intravascular pressure relative to atmospheric
pressure) lt9i1lll'll ~ni ~III nlll{~lfl11lJ.Jll ~ 1flUf1l~ItUll NllfiU~~.J'lJflll~.J un 1V1U4 ••.•••.• <I.... 4 4
l111UIllmU~n~'I'll'l1ifl'lJmVUUfll111!l~mU~l1~U transmural pressure (intravascular•
pressure relative to extravascular pressure) ~~UU~~.J'lJ'lJU~ transmural pressure ~~jjI..... d.,d ••.. """' ....•••..III 1l'l1fl'lJmeasured pressure fllllVllJUfllllJ~ Um vu Ufll111U~lll U~~~ ~~ 'lJ1l'llfl'lJ... . . .t11llJ~Um~tJlf1lllllilUU ~uYi 5 ltll~~(i~f1l~ lU~VUlttlll ~'lJU~f1iiUt11llJ~uYi1\ll1lJ
•• • 9 ,.. _,.. 9 9"9 '" Q"11IIUIllmU\ll1ll!11ty'lf ~llJllVlJltUMlllllJf1lnnV I~ IU'lJIIl~l'lllJllml~t11l~IUU ~HlJ. ._,.. ., v , ~ ~ •• i 'f1l~llJllVUltlJll~'IJ!l~ transmural pressure UUVlJlfl ~~UlJl~l~~ ~nllJ1H1U\jlJ1U
,..' ,~ i v 9 •••• 9 9measured pressure 1llJlllll'llfl'lJ transmural pressure \ll IUllm1~l'l~f1lnnV l~IU
7
D'"11U109i 1~vi1.Jtl11lJviU'I IN'tiV~I~Vl1lJUV" ~djflllyj 1fl1.Jtl11lJviu1.J11Vl 0 lfllrl v• •
l1lv'1~VVOq.llyjlUU vi~uUfll measure pressure ~djfll'1m\'lfitJ~fl'U tran~mural' .
pressure lJ10q" Invjj 017lllV '1~vVOq" '1UYIl~UijiJ9iii~tl11 r1l0111" 1~vi1.Jtl11lJviU
'IV~M1'1~,rV~1.JUlrlVl1lV'1~ vvmrfl'
-5
Marino P. Central venous pressure and wedge pressure. In: 3rd, ed. The ICU book. Baltimore:
Lippincott William & Wilkins; 2007: 182-93.)
3. Positive end expiratory pressure (PEEP) fiVIl11~~tl11lJviuiUl~Vl1lJuvftiifl1lJ~
011tl11lJviu'lJ11V101ff ii 21ll1~1.iuri intrinsic PEEP 9t~lfl"~10Q~lllJ1IJffllJ11(J
;)'UV101flvvOMl1lJfl~10011ii011 Qfl~U'IV~YIl~I~Ufllmff'lU liUgO t'tiu ~tl1tJQ~
lllJ ltl~Ylv~ l1v'Uii" l1~vl1lvi~l1e1.Jl11dvtJ Ull~ extrinsic PEEP 9t~fivIll1~~jj011. .
iritl11lJviU1.J10'1U1~1.J1.J111V'1~fll measured pressure '1umwil~~MlJ~011uo9i
ed1~ h~"llJmw~iri extrinsic PEEP 'llJuU~'lhi,rUll"ttl~V~t~e1fttl11lJviu
Idv~~10~~~ffU i ~'1umm'lfuijiJ9ifi e omU~/lUUUll~'IV~tl11lJviu (Pressure" .It. I (LI (LI Qal ~ 0<:1 q V 0
change; uP) lJ1fl0111~fl1.Jtl11lJ"U'YIu110{JllJVlJ011 Ll1ffl1'lJl (fluid challenge)~ Gl ••..• ''JISi
4. 'lIUVl'\Jll~m1'1tl!JI\l(Type of respiratory pattern) "~01ll1'11~"U measured
pressure ~ll1lJ1~l'l"lJtl111.,ilJ'Im~11l/l'1~vvoqft(end expiratory phase) 1ll1~
vi~01;111110~~lmtl ~e~ lJe {u t" v{ ~~jjtl11lJ Ufl0.11~fl'lJ1~111Hn11111V i ~lfJ~llll~
m111l/lh~1/JLtl~v~'ti1/ll1lV'1~ mw~~tl1/l11l/lhlfJ~ (spontaneous breathing) 'Im~111/l'1~Vvnl'!ft fie~ ~111~~ tl11lJviUvQiU.J11111U~lJ~qft llll~ 'Im~ ~ ~tl1/l111/li ~~1/lItl~V~'ti1/ll1lvi~ (Positive pressure ventilation) 'Im~11l/li~mlflq"fie~~111~~tl11lJ
vi'lJVQ'1U.Jltl11U~~lqft O11cllU1~vi1.Jmeasured pressure tl11cll'lJ~ln wave form
1110n11011 cll'lJ~1n~1111'111~Vtl11lJvi'llIII~/l~ U110~ i 'Illtl~v~lJV{ UI" V{
mh~'11~fl1lJ ii~mi'11~~jj 0 11tl11.Jt)lJU~~/lvi~n cimi'mr'lJ V th~~Ill\'1~fI llJ 'Vl'lJ11
tl11lJviU~1.,vdH1~lim~1~ (measured pressure) ~VVll~ 60 iiflmU~/l'lJllUll~lfJ~flllJ1l11lJ'ln9i. .(spontaneous variation) il.ilnu 4 ii~7 lJlJ.U1V'YIvi~UUnmU~/l'lJllUMnvi1.Jtl11lJviU'lV~ CVP
llll~ wedge pressure ~'ll'vlJni14lJlJ.thv'YI iiv'.'i'i1il.ijjUlJd1tlqj'YI1~tlfiUfl6
8
••il'lU Swan Ganz catheter l1111Pulmonary artery catheter (PA catheter)•
lY1VSwan Ganz catheter 117VPA catheter 1Uih.,u~v',jmUUVlm1lJ~:i~vmjv11'" .; , _I ~ ,.1 q <" ~PAC lUU lY1VlY1UVlU1VHVlVlVJereny Swan lJ1:f111jJ'lJUIUu lUI. 1970 I1nllf.U:'lJV~lY1V
v. " <1l """ff1UV11110 '!flJ. llYUHlfjUVnl11~'lJV~lY1VlY1U2.3 lJlJ.(7 French) fllV IUlY1VlJ2 'lfv~m~
'liv~H1fl~dj,j III VtU'l~,j III Vl'l'l'lJV~lY1VlY1U l~V~1fl111 rilY1UlY1UItll 1,j lllUff1V~ ~flri11~:V~iU~lH"'U~'lJtNI1I1V'lt~V'lHfI~~ll1lJUli lJfl'liv~m~luflflH~lHI1U~ 30 '!flJ.~lfl,jl11V
lY1V~~\1lfll~V i riff1Vff1U Vd1~\]fl.i'6~Hi\'1~:I~U~ 11l\1U~~IUfI~111 i ~M'6~'lJ11UU 011~
>l1lLI1U~ifli\'nu,jl11Vl'lfl'IJ6~ff1VlY1U~dhWll~U~~lY1lJ11 mihuVll~U 1M'1iJ~ l.i''lJU1fl 1.5
lJll. mWff1VlY1U~ff1lJl1(rlfi cardiac output 1f1V1n thennodilution U~nf.Ul'h~~lfl,jl11VlY1V
lY1U4 '!flJ.~:iilY1VlV16{jjfflfltJ{I~61'lflW I1lJii (I,j~ 6) lY1VlY1UlJlfl1jJ1U~:iilJf.U lYlJU~
~ ~flrimj1~.i'u H~1J~~uuiifll1~I'lIU 1ff1VlY1U1M'iiml' 1~ ri116~l1ll1VtJth~ m WlY1V, , , . . '"
lY1UViiil1U1Viri11V~liilJl~lJiJU '1 ~:iifl,jm ruri116~I~Um~I~,)flliilJl~lJ.,~ii• Temporary pacemaker 1f1Vfl1~.1111I1U~14 '!flJ.~1fl1Jl11VlY1VlY1U~:ii,jll1VlU'lIYi6
lY1lJ11(1i rilY1V'IrJYl1tYi6~1fll1 m:.'iu M,1 ~M'V~'lJ11ri1~1t!•i ~... 'J• Continuous mixed venous oxygen saturation UlY1Vff1UfI~nI111~:lJtJ~m 1:n6U
'lJtJ~fiberoption system ..• Ejection fraction of right ventriclc ff1VlY1U~:lJ1:UU rapid responsc thennistor. .Q" V Y o?l• Continuous cardiac output lY10lY1U~:lJlY10l1lY1lJ11(1ff11~fl11lJ16U'lJU1flm '11UU.. ~ '" .1:0: '11VltJ1f1cardiac output II1JUthennodilution 11l1:110~lUHl1lUU'lf1~ '1
• Proximal port• located 30 em from tip• CVP monitoring• Fluid and drug administration
• Distal port• At catheter tip• PAP, pewp monitoring
• Thermistor• Proximal to balloon• Measure PA blood temperature
• Balloon• At catheter tip• 1.5 ml inflatable
Pon to 1Mn--~rIJP<lo1"' •.•• ~ <Il:-__
~f'DI'I (01)
9
Imiull'lUll'"J'II PAC
.Jlmllj~~Hffllli'lJ'lril'nV PAC ~lrU~Ul~lJ Right intemaljugular vein 1l1lJ Left• • Sf. '
subclavian vein l\jlJ~ ~lm1'JmilLLllU ~-nrrlVl1fl'411111lJl~Vl'trlJV-nl'!VlI11V11l1~~lfl-n '1~'lrirrlvrrlv
rr"J'IIUl (introducer catheter) ~1V1il modified Seldinger technique LLii'1l~milfln'lrirrlv PAC. .I 0.... 0' •••• ~ ••.•• <:!I ••••
fll'll rrl Vrr1lJlJ 111lVll rr~~lfl'l'11fl1~'IlJ rrl V rr1lJ flUlf1~lJ~'I ~1~1fl f1rrlJ f1111lfllJ (pressure
monitoring) LLrr~'I'1ii\rrlJUlJlJrr\1lJ'hvh~llJ'I~~ InlJ'lrirrlv PAC 'I~lh~lIllU \0-15 'lfll. 'l,rlilfl1~•
lthUlJ<l1llJ1HlIllU 1.5 lIrr.'l ,rHh~1Vml11fl ~lmrlJlilfln 'lrirrlVrr1lJ gmoU'l'I'l.l if ~lfl'l.J1LLllU~•
'IIlJ~'l.lmVrrlV~1fll1mj\ll~ f1~lJfnlll~ lJ (pressure tracing) 11mllU ~'IIlJ~f1lilJf1111l~lJ~~ll rrf1~
1f1vif~I'll'l.l'llJ,'l.l~ 7Wedged
pulmonary Artery
'"
Right Atrium30
'0
o
'0
o,'l.l~ 7 llrrVl~l1mllU~f1BlJf1111l~lJ'llJ.J11l1lU~';1~ '1 'lllU~~lill11~'lrirrlVrr1lJ PAC
(~Vlll'l.lM~lfl Marino, P., The pulmonary artery catheter, in The leU book, 3rd, Editor. 2007,
Lippincott William & Wilkins: Baltimore. p. 163-179)
• lnlJ'l.lrrlvrrlVllg'llJ.JlIIl1U~'IIlJnlrrlJVlllilJVl.Jl'lmy (superior vena cava) l1mjlU~f1BlJ
f1111l~lJ~djl1mllU~'IIlJ~ venous waveform ~~mi1111loU'l~~lJ fh'l.l~fl~~lJ \-6 1I11.'l.l~lJ'I'1
•• I11Vlll1~~lflrrlVfhlJiilJ111'l~ tricuspid 1.,j'1~M1'lil,rlJ~riH'II11 l1mjlU~f1lilJf1111l~'II~~
1'l.l~VlJ'I'l.l'l11l~~111~'IIlJ~11rrlJVlllilJ'Illf1~~~~Uf1111l~lJ ~ ~l'!fl (systolic/peak pressure)
1.I~fl~'l.l~~lIllU 15-30 1I11.'l.l~lJ'I'1ri1lJ~~~U~1l'!ii\ (diastolicllowest pressure) ~~il
ti 11.l1~1I1lUf1111l~lJ'II!J~11rrll"lli!J".J1 'lmyiilJ 1-6 1I11.'l.l~!J'I'1. .
• ljj!Jrrlvrr"JlJl-hlJftlJ111'l~ pulmonic loU'l~pulmonary artery (PA) ~~if~lfl'lil~~ilfl11
l~lI~lJ'IIlJ~ diastolic pressure hw'lllilflm'l.l~VlJ1l1.l1H'IIlJ~ systolic pressure 1ii\V..t1'1'l.l
~~~lJ'IIlJ~ PA diastolic pressure 'l.l~~lIllU 6-121111.1.I~lJ'I'1
• lnlJrrlJflrrlVrr1lJ i'l.ll~ lJV'1 ~lJ'l.lrrlvrrlVrr1'11~~illJ!J rr\1lJlJgllflWlJII rrlJVlllilJflllii\~~~
if ~lfl'l i lf1BlJ f1111l~lJ ~~11.l~VlJ~1fl11BlJ11111l~lJ 'IIlJ~:JlVl~~11'JlJ f1BlJf1111l~lJ 'IIlJ~11rrlJf1
10
~ 0"''';' ••..••.. I • .•.•llltl~Wl1L7tJfll1lllJl111lJl1lJl1~mn111 pulmonary capillary wcdge pressure (PCWP) 11711
Wedge pressure 1111lJ~ lJ~~mi 11L1JlJfll71111111:::1lJ1111lJ~ lJ'I tl~1111~11'tl~~l tJlJlJ~~flri11
v v I .:.'I'd' 1 Vd I .,. .....; ,d " ••..'Il~l1lJ I1tJll1 Ufil Wedgc pressure lJl11 flllll1tJ~ I1tJm:::l1lJI11fl11111fllJtltJfllJPA.
~ d d ........' 1v 1 ' ~.ldiastolic pressure IlJlJll1lJl1lllJl111lJl1lJl1~flm1 1111QI1fll7 l'fl'fltJl'f1lJLLll:::'ItJlJl'fltJ'IlJ.
"1vO ,all~ Irw 11111LLl1U~'I'I'I'l1l1l11Jl:::, . " . .
• iY~lhti'qjVil'l111lJfll71lTl'fltJlnlJfill 'lJfll1i'~Vi111flWll1wedge pressure 117tl1lJ'Illldhll. . ,
fl17OtltJl'fltJl'f1lJ 111'111fll7~ I1lllJlltl fl~1fllJ IIII~U llfll1 i'~IYllJ'l'l11~tllJ1111:::1L'I'I7fl~lllJ ViLill1
~1fll'fltJ l'f1lJ flltJl1l; ~~lfl~ M., lLLmJ ~~ 111lJl:::l'flJLL~1111'111fll71JlJYifl"111mJ ~'I tl~l'fltJo odl 0 I ....'
l'f1lJLLll:::'I'llfl17117~1l1LLl1lJ~'Ill ~l'fltJl1~flll11
i1qjVil1lJ'Iw:::mliil'ltlil'1lJ1
• 'I~l'fllJ170l'ftll1l'fltJl~1~111 hl1' tl~'1111 Il1tJ~1 'IUlrltl 1lTl'fltJl'f1lJl17:::1Jl1ll20.25 'lIlJ,~:::
1~1~111hl1'tl~'I11riN 1lJlJl~mtih'lilJ n tricuspid regurgitation 117tl 1111~9ifl'l11•• •
~lJll1ll1 fll71lTl'fltJtll~~:::Vlfl fl171i'1l1Ifl~tlViU71ff~lflltil{J1lTI~11lJlJtlll~ULL'I'IlJtllfllff
.4 , :.... d " 'I".... O!:!:l •••• 1 vm II111~lJll1lJ fl'IItl~l'fl tJll~tl'lfu:::m ~m U 'II11~fl17 l1llVtllJ fllllJ 'IItl~III{J11'IItl~111 ~11tl~
'd 8llN'lIfl'l11
• i~l'f11Jl70l'ftll1l'fltJl~1~l1ll11111~{)mll1~~llllJlJl11I1tJ~1 i Ulill1~lJ~lfll'fltJl'f1Unfll7'111
.l11lJl111 ~11'tl~ril~'1111 LLOi'lll1tJfll70tltJl'fltJl~1~l1lltll1l~{J11"11 mYLL~1titlV '1 111fll7
1v'l •• v'., ''Id ., ~, ""'Ivl'ftll1l'fltJ l1l'fltJ l1llIl1lJm:::LLl'fllltll1l'111ljutll1 tlVl~ 7flmlJuqjl1ll1~flm1~:::LLfll'l 11
tJlfllJlfl1 u~"htJ~iiIl11lJ~lJ 1lJUtll1lj ~
~ v ~ 1 Q.' Q d Q .1 'Iv ' v 1 ~ 7• ~~111:::fll71IlU111 ~Hl1u7flll mlV~lUlfll1'11U I1lJlflfl117tlVll::: 50 lJlJl~fllHtfllJl
lT1u1my1ifli~vlJmltJ1Jlfll!fl mW~iifll71~lJ~HI1~~111:::1Jlfll'lilJ complete heart. 'block 111'111fll70tlUl'fltJtltlml~l1lJl1nlJVi LLll:::11l1tJlJfll7m :::~lJI11h'ihl17 11
..,. •••• I Q J '1vQ d(transthoracic pacing) mllll1~flm1Ifll1'1U~lflfll7l'flVl'f1lJflll mfll1fll7lJll1l~lJ'IItl~ AV
node
'I,d •• • l' i"" v d ~ , ••• lJl'fllJ170ll1lJ wcdge pressure I1~LLlJ~:::l'fl'fltJ ullfllJlflLLll1flmlJ 'I'l'lJfll1:::I1~flll110~
v 7 Q~' Q.liv • 'I"'" , •• 'I'7tltJll::: 25 mllll1~flm1Ifll1'1lJ l1~lfl'lJ{Jll~U'I'Il~lU 111lJl'flJ\!711l nlJm'lJ{Jll~U lJ•
l'fllJ17011I1'11ll{JI1I~{J11~lJmJI1 tlril~ \17~1l1lJ1U'lJNI1i' ~~ 'I~ l'fllJ170lllillllnlJltJ MmW~~fl~11tll~llljlJllJti1 wedge pressure ~lfl PA diastolic pressure 'I~
011111 cardiac output
111111Vfl171'1'1111111thermodil ution III VtllftVl1l; flfl17fitJ1J~lJ1III'I{J~I~tll1~:::11117Hfl~lJ tl'lJ. ." . ,fll71UiitJlJ LLUM 'IItl~11llll1lJii 'IItl~I~{JI1Ii'i{Jiifl17 ii11l'f17111Viii 11llll1lJii .,11~1~1111~11'tl~'1111lJULLll:::~:::iifll7 ~lJfll71U~ tJlJILUM'Ill~ QlIll1lJii~UllltJl'fl Vl'f1lJ9 111~tl~1l71 ~~lJ ~:::111fl171JlJYiflfll7.' •. ,
Iuii tJULLUII~11llll1lJiili'itJl1ll1HllJ 'IULLll:::1111Jl1LI171:::\1HllJ m ll~ YluVi1~m lTI'IItl~11llll1lJii LLll:::.
11
11111ii!HjVl~1m~ 11111'IJIl~l~!lVl~lm11'~M!l~'IJ1111JiJ~1111!l~L~IlVlUVl~~1l1lJU11 , umtU~ ltJiJ
ltl'uYl1~liVl'IJIl~I~!l~'U111'1~ (intracardiac shunt) fi1~~nri11m~11:IU l~v1J~:lJl\lHl'hn1J1J~lJllll
L~!l~'IJll~111hM!l~~lV• ••• J,I •
11linm~1~ml111J'lum11f1iimii!l '1i'rrmJ11tJi1 ~:I1'JUU1tn~!l11!llrr1~ ll:lllVViiJJ1mll~iJfllll11lJiJ~lUll':' i'1J~lJ1111~lJ1n~:~il'1Mth~ M ~lnm11f1\Jn.rll~lJln~U 10 ll~l~i~~
,~:, ""')1 QQJ 4""Vf!kl)./' QJI "" ••.. I 0mlJm1 'lfrr17U1Ufllll11lJlJ11ll~nV~rrllJl~IH'lfllllll.IVllur;!thv11unI." 'llJmlll~Hnlll111lJ:lJl
'MiSf1'llJ1J~lJ11ll~lJ1n~uiill10 lJll. ~:I~Il~1l1.rlJ1nni15lJll. n171f111111V'1 11f~Ull:U1lJ111l
till\l~v~:1~fi1~utJlJU11J1n~lJ 'llJmtU~fil~MuVln.h~nlJltJlnlJr!lVll: 10m11Vllilv~ 3 11f~~, "
lilvn'w 'llJm liiiifi111VlnviHnlJlJ1nni1fllVll: 10 '1Ml'iln171f1111~vill11Jllll:U1fi1iillVlnvi1~nlJ,. .llllviil!Vl 3 111~lJll1lfi1l\l~Vm1lJll1J~1JnU'IJll~n171f1 cardiac output ~1v11im~~~nci11iJ. , ,, ./ ~ '1 ~ ~ ~:I 13~ ~ .I~ .1 ~ • ~ ••mu~:lJ1111~!lVll: 10 \Jrrfll1:1f1V1nU'lJll~r;ju1V f1~UlJm~lullVUllull~l1lJ1nm1~!lVll: 10 ~~
~!lM 'hiJm1lJff1fiwYl1~11i1iJn !l~l~iJ'I!mi1tlwu u
,j'!lmn:1~'lJll~m1u1JllNlll~uri ~1J1Vtricuspid regurgitanion 9t~rr1lJl111111Jl~\J
~t11V~'i'PEEP 'lu~t11v11'1!n Nll~~nci11l11'Mcardiac output ~lni11J1n~14 'lJmtU~~thviJ•• " "'" • Q ••• d.mtracardlac shunts U1Jllnght to left shunt 11~!lleft to nght shunt nmlJ flllll1lJlJ~:llf1ll~111m1.IA.'l~' .1u1nVl YI111cardiac output lJ~'IJ\J
fil~-J"'A'lln PAC
fi1~1VlM~ln PAC mj~l1'JlJ2 n~lJ11lin 1~llri vl1u1J~~llJl1l1ff1rrVlf'U1:1J1J'111ll11V\J
1ll\1Vl(Cardiovascular/hemodynamic parameters) Ull: vl1u1J~~llJm1ullm1J~VlJllll:n17'IJlJri1v
ll!ln9l1~U'lJ~HmV (oxygen transport parameters) v1'~urrVl~1~'luVl1n~~1 lVlV~111Jfi1~MiJ. . ,~~fi1Vilri'~lnm~1VllVlVm~'lJrr1V PAC l1111J'hluri CVP, PCWP 11!!lWedge pressure,
Cardiac output Ull: Mixed venous oxygen saturation ffl1111J'llJ2 v1'1U1J111li~mtU~l1'Jurr1v, . .
t1LfflJViiJml1Vilrr~lJUll:fJlllrrlJU~t1lf1lJrr1lJl~111f19i1U1J~l1~rrll~lri'ltllJ'lh~ '1 Vlll!lVll1ll1l.W '1tJ
iJm1lJ ~11tllJ vlll~isVlJllglJ 11~m~1: L~llVl~lOll lllVrr1V'1tJm 1~ItllJ 1: V: '1 Ull:' lJrr1VVilfflJ1JH
'lfiJVliJ~rr1lJ1~1l1Vlright ventricular ejection fraction M~~rr1lJl111u1'11Jti1lJ111111lright
ventricular end diastolic volume M I'hu'\Jfil~\J '1 ~'M~ln PAC ltllJti1~1~~lnn17tillJ1111
(secondary data; derived parameters)LrlllU1fi1~1f1fi1~'1lJ11.u1~l\'lJm1~~Urrf1~'l\JVl171~~I
Cardiovascular parameters
~1U1.h u • ufinhnPiI'I1l'JfI 11111., 'lUJl!JI'HOj
Central venous CVP 1f11f1VVlH 1-6 lJlJ. 1J1:lJllll n17
pressure 1J~1l11 CVP=RAP=RVEDP
12
Cardiovascular parameters
g(ll1\h v • v
fluhnPi1'l11J!l nl'nl'l mnlJl'l1"JPulmonary capillary PCWP 1~1~W91H 6-12 lJlJ. lh:::1Jl1llnl1wedge pressure t1HJ'I1 PCWP=LAP~L VEDPCardiac output CO 1~1~V9l1~ 4.5-5.5 flllltl1t1nu ~V!JlJ1U
Umin i.l"h.iLiiu1!JVn::: 10Cardiac index CI •
2.4-4 Estimate BSAfllU1111
CI =COIBSA Umin/m' ~[Ht(cm) +Wt(kg) -
60]/100Stroke volume SV fllU11l1 60-110 fllU11l11u~tbtJI11
SV~COIHR mLibeat 1~I~utl1n~Stroke volume index SVI filUlll1 40-70 Estimate BSA
SVI~SVIBSA mLibeatl m, •.• • tI SI
9l~n1ll1'\11~91ULeft ventricular stroke LVSWI •
40-60 g- 0.0136 fi!Jfil~HtlfufllUll11
work index LVSWI =(MAP- m/m' ~~lnfl11lJflUlln:::
PCWP) x SVI x t1~lJlmLl'lu
0.0136 ,l1U1tmu
Right ventricular RVSWI • , , "" QI'" tImU11l1 4-8 g-m/m l'l1UL~W1nU'\lN91Ustroke volume index RVSWI =(PAP-
CVP) x SVI x
0.0136
Right ventricular RVEF 1f11~V91H 46-50% 1~lY1VlY1UVilffllejection fraction
Right ventricular end RVEDV fllUlll1 80-150 fllU11l1 MlIlrn:::lY1V
RVEDV = SVI, ~diastolic volume mUm lY1U 'I'H fflJ
RVEF
Systemic vascular SVRl •1600-2400fllUll11
resistance index SVRl~(MAP- dynes-sec-
RAP) x 80/CI cm5/m2
Pulmonary vascular PVRl • 200-400mU11l1
resistance index PVRJ~ (PAP- dynes-sec-
PCWP) x 80/CI ' 'cm Im-
13
Oxygen transport parameters
Mixed venous oxygen SvO, 70-75%
'Imlm'l1~
mL/min/m' Hb mhv g/dL
13.41i1f1~lhJfl~nu
ui'umi1v
saturation
Oxygen delivery D0, r'h1.l1W
00,= CI x13.4
xHb x SaO,
520-570. ,
CI H1.I1VLlmin/m
Oxygen uptake
Oxygen extraction
ratio
VO,
O,ER
VO,= CI x13.4
xHb x (SaO,-
SvO,)
r'hll1W
O,ER = VOIDO,
(xl00)
110-160
mLimin/m'
20-30%
~m.l 1mh ~1f1i~.l~ n ri11~11,r l'mm (l ~1LLIIn f111lJHf1U~n9i'I11~f1liiJnHIIIVUn: m~ i~LLri1. nmnj~'JjiJf1'IJIHf111lJ~ll1m1\il~1
li1IJ~~lnf111lJ~ll1m1\il~m-Hl~wn:wh~ cardiac output LLl1:::SVR (MAP=COxSVR)
l'f1lJ1~mL,j~'l1iJf1'IJIJ~~"hv~iif111lJ~ll1m1\il~11i'Jll 3 milJmlJ~1LLU~'lJIJ~ PAC ¥1~LLl'ff1~l1.1
..;\il1~N'I12
\il1~N~ 2 LLl'ff1~m~LL,j~'JjiJf1'IJIJ~f111lJ¥1ll1m1\il~1mlJ~1LLU~'Wl1fl1l'f\il{~:::uu iHl1liv1.l
'lJ1HPAC
Hypovolemic Cardiogenic Vasogenicl Distributive
CVP ';1 CVP l!~ CVP ';1
CII CO';l CI I CO ';1 CI I CO l!~
SVRll SVR l'f~ SVRII SVR l'f~ SVRII SVR ';1• •
2. m~LL,j~'JjiJf1'IJIJ~111ht1'lJLMl11~:::'I'I11~heart failure LLl1:::cardiogenic shock
11.1~1J1v~ ii1111:::1111~t1'lJLMl11l'f1lJ1~mmn m ~~ m1.l ~ Hf1U~n9i1mJlJ1ffV.l1LLU~m~. ' " . "'lJ1.Iri~lJlJn9il~ll lijlJ~~ln1111::: shock 'I'IlJ1VO~n1~lhi1lJl/jlJlhllUIllViin1~'lJ1f1lJlJn9il~ll ~~Ull
~:::~U'IJIHoxygen consumption ~:::Li'Jllvi1~:::1J111J~lll1111:::¥1~nri11'1'1~lJilJ¥1~LLl'ff1~lllm~l~~3
14
f1UN113 lllT"~fl1~IWm~'wiN heart failure llfl~ eardiogenie shock
Heart failure Cardiogenie shock
CVP lJ~ evp lJ~
el / CO 911 el! CO 911
SVRlI SVR lJ~ SVRII SVR lJ~
vO,1.hf19i va, .11
3, fl1m()m~111N right llfl~ left sided heart failure
~iJ1()~jjm1~M11~ti'lJmfl1~~jjfl1~11.l~()'UmJM'lJll~v11mhv1~1'Umm~ 2 l.,()~iJ 1()~
jj right sided heart failure ~~jj evp lT~llfl~pewp l.lm9i111ll~1 l'U'lJw~~~iJ1()~jj left sided• ••heart failure ~~jj evp llfl~ pewp lT~11~lTll~v11111.l~•
V ....,dv IV
'lJllfl1"~1~lf)1'J1n'tJfl1'1VlCVP Ull~Wedge pressure
1. mllJv1'Ul1Jl'li1.l1lJl'" ~~fflr1ty~l'{"l'Ufl1~v1"ff'Uhf1U fmJ1~iJ1()~jjm1~.jIllfliill•
fl1~1.l~~LiJ'U1.l1lJ1m'IJll~lTlnl11'UM11~(proload 111llend diastolic volume) ll~llril~l~nVlllJfl1~
Hevp 111llWedge pressure L1'I'Ufl1~1.,mllJv1'Ul1Jl'lifl1~1.,1.l1lJ1m v1~l'Uf1uflmn'IJll~
Kumar llfl:;flW~'Yi'tJ11evp llfl~ Wedge pressure ii''tJLVEDV l'Ufl'Ul.l~f19ijjmllJff'lJ'\;'U{ii''U~
lJ.i~hrf11.,()jjlilr l!!JVf1110,5 r1~Il!T'Hl'Ull.l~8
A r = 0.0305 40 B120 • r = 0,3302
P • 0.9251 ~~ P = 0.2945~ • E 30.E 100 - • •• ..J...J • • • E 20 •E -:: 80 • ;> • ••:> • • • C 10C W
•• •
w 60 :>0:> • 'l:
'l: <J • •40 -10
4 8 12 16 -4 0 4 8
CVP (mm Hg) t>CVP (mm Hg)
C 30 090 ~ • r = 0.33770
r = 0.0492 N P = 0.2830N • EE 80 P = 0.8794 0 :J 20 0
:J • •• • E- o
E 700
• • 100 ;> •:> 60 • C 0 •C • W •W • :> 0 • 0 0
:> 50 ~...J
40 -10
0 5 10 15 0 2 4 6 8 10
PWP (mm Hg) 6PWP (mm Hg)
15
~1J~ 8 nl'fMfI11lJfflJ..;'\l'li''U!l~CVP nl1~ Wedge pressure (PWP) n'll RVEDVI nl1~ LVEDV1
~llJih~'ll
(~"n1JM~ln Kumar A, Anel R, Bunnell E, et al. Pulmonary artery occlusion pressure and central
venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to
volume infusion in normal subjects. Crit Care Med 2004;32:691 -9.)
o,d .;" QI QI ..,i,.... "" "'1
2. ~lnl1\l~YlLl1lJ1~l'flJ'U!l~l'f1Ul'f1\lPAC L\ltl~~lm~"lm11lJ"\lYl1"~lnmHl"ll1tl"l'l!l
fI11lJ,]\l~fflJ..;'Yl'Ii'n'lll'l11lJ~\l 'll~~U1111ftn~ I~ tl~~1n~~~1.1l'l11lJ~\l ~ii fll1~tl1J~lJ1~~'Utl~'litl~tln
-l ••.. ••...•.• QI d' I 'l a _I d ''l'U\ln1.1fI11lJ" \Jl'flJYlYl1i~~1111~111U \l nl1~111U\lVnl1l1V" Il1V" n11~lJ111Ul'f1Ul'f1\l'UV~Yltlg \l
1'11nl1\j~~1~'1 'U!l~1Jll~iili'\l ftlft'1!~lll11~n1Jl1fll1~~mi11
l~ tl~~1n l'f1Ul'f1\lll~'l\J1111tl" l~!l~ n" ~~~ll~'l \l1JV" fI11lJ~\l liln U10Ull~~~1J~~nll'll ~1U
~ ~ d
fI11lJ"\l'Ull~(j~l1lJ (Alveolar pressure; P.l fI11lJ"\J'U!l~l1l1llml1ll~n~~ (Arterial pressure; Pal
~ 'l d.1 d I ••..• !V 'l" " .nl1~l'l11lJ~\l \ll1l1ll~Ll1ll~HllU'IH~lln'lll1ll~ ~l1ll~'ll\l911U(Capillary pressure; Pcl Left atrial
pressure; PLA
) fI11lJ~\l~i~llvmj11~tl~!l~l'{~iitlI'11nl1\1~~ Pc lllnnl1 PA 1"uI'1111l1\1~
~~nci11ll~'l\l191\l~ 3 'Ull~1Jtl"~~Ill'f~~'l\l~1J~ 9 ~~1l~11~~'hjl'f11111m~1jY11~mUll11l'l'Ull~
191\l~~n ri111~tl~~1m 1'1\Jn 1~nti~i9l\l ~ llJ l'f~~ft1l'f~n~m 1'1\l9111111'Ii~!l~'l;; ~!lM1'l~11'tl ~'ll\l~lU I
~~J\l9111Ll1'1i~'Utl~1Jl11Ul'f1Ul'f1\lPAC fI1~ll~~ln11M1 'l~11'tlm\l~lU tlV1~'t~~~llJl11Ylci1U~llJ
1J1n~~ln AP view 'tlil'f1111~(\'lJlln9111Ll1'1i~~~nri11 't~ 111~~n~l11Ylci1U'l11~~~i1~Ll1lJ1~l'flJ
d 4. I iI iI ' nl " 0' ' 4. I'l1l'{"l'ltll11YlmUYlH"1\l'U1~ 11l1~Ylm1lJ~~lJ1Ql~tlUI1~30 mlLl1\l ~'Utl~l'f1UPAC tlgLl1\l !l~!l
~ 'l" "1 ~ -IQ
- I ~ ' ~l11 ~l1!l~'ll\J911U ~~"'ll'Ull~ PA LlJl1U\lLllJl1~mm~"'ll'U!l~ PEEP nl1~Yl'll11~~"'ll'Utl~Wedged • iI iJ .d~J"1
pressure ~~I1JI1U\ln1Jl1~llUH\l!lmllUl1~ 50 'Utl~PEEP 'l1LYllJ'U\l
..- •.•..•......•.... - ..
(Pc - Pv.)---_ ..•....•.... -----(Pa. PJ
~1J~ 9 llrr,,~ 191\l~1~ '1 'Ull~fI11lJ~\llmU1.1llium~1111~fI11lJ~\l'Utl~l111!l~I~ll~n~~(arteria1
pressure; Pal fI11lJ~\l'IJV~l1l1ll,ll~ll~f1llU(Pulmonary capillary pressure, Pc) 1111~fI11lJ~\l'IJll~-
16
CJ~lnJ(Alveolar pressure;P,) (~~llUll~~ln Marino P. Central venous pressure and wedge
pressure. In: 3rd, ed. The ICU book. Baltimore: Lippincott William & Wilkins; 2007:182-93.)
nn1j'Wij.••.jfl11~1iln~lwtJll~PAC 'tI1ll::'1hnnl~ wedge pressure 1l~ll.jyj'lJiifl~'WfI11~~'W
'tI11~'I11111.11Bll~~l(damped PA pressure) i'Wnnii~~m;'l11WYill~/lmn(i~fllVll:: 50 ii1nnn
VilJ~tl':hd'I'Wwedge pressure ~1iln~Il~'I1iII~~1~vm~ l~l::IBll~91n ~'tI01::~'1hnm1Jlllllll~'Wi '"•
Yill~(Wedge blood gas) 1~Vl1lnYill911~LnOl'li'ri'~~II~uiHill ~/l':h9i11ll1l1~UlllVl'I1V~0I::'I11m~}I .•.•. I ..: tJ IS.•.•.Lulllllll~'Wflllfll wedge pressure l1~n~ll~ flll
• Wedge PO, - Arterial PO, 219 ~~.U~Ill1
• Arterial PCO, - Wedge PCO, 2 11~~.U~Il'll
• Wedge pH - Arterial pH 2 0.008
3. hflllHlllh~lll~'I11 i'" Wedge pressure ii~::~llfl11~ri''W~~I'Yhnll LVEDP Mlln hfl
'I1illflll::~'I11i",if'W111i~~~l1fll1Jm~')n':hun~ 1'li'Waortic insufficiency 'I1ill noncompliant.£ ~ "'..: , &'t QI V ..,;.,.
ventricle 9!~LVEDP ~::m::~lll1lJ~ml Wedgc pressure 'I1~Ill1Hm~n'W'tIl~ fll,)::l1~fl,)llJ
H~U~n~'tI11~'l1111fllBll~~li'WUllflt'li'Wfll')m~ Ill''111vi~i\'~Ll111,)~::~llfl,)llJ~'W~l~ 1A'tIll~
wedge pressure ~::ii~::ri'lllJ~n'jl LVEDP 1~'W~'W
4. Pulmonary capillary hydrostatic pressure (PCH ) 'I1lJ1V(i~~::~llfl11~ri''Wi'Wll1111fltBllfi
~IlV'tlll~Ullfii 'Wl'Iml::u~n~~iinn ~'I111'tlll~m::lllllBllfll61f1V~,)~U~::~llfl11lJ~'W'tIll~Wedge
pressure ~::iifl11lJllflf1~1~nll pulmonary capillary hydrostatic pressure ~~mnun ll~i'W1J1~"'" '" .•.• """ .•.•mOl~::flllfl,)l~fl'W'tIll~Wedge pressure 1ll~~fI11~llflnfllmll pulmonary capillary hydrostatic
pressure 1'li'Wfll')::~iifl11~~1'W11l'Wi 'W'I11111fltBllfl~1'1~1l1~'W,;lJ~i'W~1J,)1J~iitm::l1,)i~i\'~Ll111,).•.•.V~'I .d~ d 0 9. " q ,. ••••
'I1~Il~u,)Vl1~flll:: pulmonary hypertension 'Ml111l1tf1f1fl,)1~llflnflln::'I1,)1~fll1~f1'W'tIll~'I11111fl
LBll.lllfl~IIll::~liifl11~llfln~1~n'Wmn i'Wml::Um~~l PCH ~::ii~lU~::mOl 2 ~~.U~Ill1 ~~
l'I~m~i'W,u~ 10 llll::~l'tlll~ pulmonary eapillary hydrostatic pressure l'Ilm~I1'111~/l~ln~~~f1
~::'I11H~f11U~V'W~::w.h~fl~'WfI11~~'W~lnpulsatile pulmonary artery pressure ~UV~nonpulsatile
wedge pressure 1f1VllQ~::'111l~~fl~fI'tI11~tU'Wl'I~lJ~'tI11~fl~'WfI11~ri''W~llflM lllh~~ ,)f1L~') (initial.••. v ••• ~ .•.. ..i I tJ ••••••• • ••••.
rapid phase) nllll'l'Wl'I~~fl'tlll~flll'WfI11lJfI'Wl111flll~llVWlfl'1 (slower phase) ~f1flflfl~nlll,)f111flll
fl01'tIll~fflJU~::ill1t~1~ 'tI11~m ~LIiVfll1l'W~Li1f1~'W~In'l11111flIBllfl~l~ 111~'W,;tlllfl11lJ llfln~H•'tIll~fI11lJri''Wl~~V'tIllmllllflLiillflllfl~~111lJ'Wl~(Meanpulmonary pressure;Pa) llll:: Wedge
pressure (Rv /j.P) ~~lll'lfl~i'W,u~ 11 lllh~1~~fl1lJYi1l11~f1~f1~~nlil1~~l'Ilm~1111l~~'W~1J')v
tl'IlJII1U16-18
(Pa-PCH) (PCH-PCWP)Rv
PCH -Q~
PCH-PCWP=Rv (Pa-PCWP) ) +PCH= PCWP + Rv (Pa-PCWP) PCWPPCH= PCWP + Rv ~P
17
'i:,j~ 10 Ltll'flHnJfll~fl11lJfflJ~ui'lIN PCH [Pulmonary capillary hydrostatic pressure], PCWP
[Wedge pressure], Rv [fflJ1h:::ff'l1(~llJ'lJU~Lt~~lftVflmu~Li1fl~u~lmHlllmiiufl\~h] Lt<1:::LlP[
fl11lJLtflO~N'lJll~fl11lJ~UtQ~V'IJU~l1<111flliillflLtfl~~<11lJlJl~(Mean pulmonary pressure;Pa) Lt<1:::
Wedge pressure] (~flmJ<1~~lO Marino P. Central venous pressure and wedge pressure. In: 3rd,
ed. The ICU book. Baltimore: Lippincott William & Wilkins; 2007:182-93.)
,. Balloon Occlusion
Capillary hydrostatic pressure;PcH
I----------------;;~-~-;---~- --- -~--_______________________________________I:CJlVP --------
'i:,j~ II Ltll'fl~fll111l~1'IJU~capillary hydrostatic pressure ~lOfl~Ufl11lJ~ulu'Iw:::~.;hfllWlh
lJU<1Qulu PAC (~ml,j<1~~lO Marino P. Central venous pressure and wedge pressure. In: 3rd,
ed. The ICU book. Baltimore: Lippincott William & Wilkins; 2007:182-93.)
<V Q _I OJ ~l1i.!Og,.IlI11~'U''l:::\lO'll'IJll~CVP IIi.!:::PAC, "'" .
LtlJ11,rlJ'lJll~fl1~H PAC lu~,:hv1119f~ijLtU11,rlJ<1fl<1~L~llV'1 'I1~ihijll~~lOfll~lrill'lV•
ll'1U PAC Li1flm1:::U'l1~O~UU'1~lJ10 li0'l1~OU~\IlllJll'l1fl1u 1<1V'l11~fll~U'Vi'I161UDwuuri~HCl•9" ~~.I' ';9" .111ll'llJU()1flfllLt1J~fll~ '1 'I11fl~lO PAC l'lfUnon-invasive cardiac output monitoring,
~ ,.. til v"'" 'JI '" " .,,1.echocardiography LllUflU Wiener Lt<1:::flW:::lflflflflllJLtUl1UlJoul'1f PAC lU'lJllll~'lIfl1~ '1
lU'Ib~ 10lh:::l1'h~ 1993-2004 lUl.h:::l'I1ffll'Yl7jjllllJ1fll'Vill';hijouH<1fl MrUVCl:::65 ~lO 5.66 -
18
• •LMiil11.99 1li'~~l1 1000 1li'~'lJl1~flWIW'Uh~'~V1Ulll (risk ratio;0.35, 95%confidence interval;
'" ,~' d d "~" '" ~ ~ '1 - "'"0.29-0.42) Ull:::llJ!lLWflflllJfl'llJ 111l9lN'1 fl~:::tI1llLIll1I'UlJl'1M\1l~mlJl1'Ufl'UU9I'Ul1mll'1 lJ
Llhn'Ufl~Ul'I9I~1'U,tJ~ 12 ffl'UM5flill'UL;~tJ1:::~mJ1'Ufl1~1~ CVP M~l1PAC 111fl11~91f1llJ
.• 1"~ -' " ,Q i" Q.' '"1"~1lJtl~fl1~ 'I1mU1J~1l1'Ufl1~'IJ'Ul'I~l1l1fl'llL~'U~lflPAC~::: 91l1fl1JnV9Il11J
1°".'1.200'
f:!iJ'fJ~~\oIW" um •2004 •
WlztlqRNI.'VIIl'l" """,.:,{.• w:- " 't'~, """ -.-
nfl"nll iitl'lo4,1~fl'ltl 1m -0-
2004 .-~"l~f)~ ...~.~:l;r.. """ -<>-
.il.•• """ '.'\1'11'"tAJ.H\4fl'1
,,,.., -0-
2004 •U'ilMm8l\J ,003 <>
2004 •
FWt RatIO t9~,*, Cf)2004 V) 1993
] o 3.:' i02'9.0 JZ!
] 046 (0.36-0.541
] 0.35<02'8-0.12)
] 0.25 (0.17-033)
o 10 ro ~ w 00 00""u'1ll.n"lil'ri PAC Ji!! 1000 ",t~Jintl>ln'WUtl\l m, i9S'l\ OJ
PAC,!J'thtl>lili'!lti~:t1.l1l~'lI'l-.q~t1-.q1\JPAC;CI,""~1JA1~)JL~mt\J. . .,tJVi 12 Ul'I9I~U,r'1,rlJ'lJl1~fln1~l'Ilv PAC fIllJ.,j'mj~*~l~ '1 VillIlM1'U'lhn:::v:::11111 10 1'1
(flIlUtJM~lfl Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the
United States, 1993-2004. lAMA 2007;298:423-9.)
Central ,'enous pressure (CVP)
jJ 2 fl1~ffmll~111fl11 ffmnU'tJ'tJ~lJUll:::itJ'Ii'1~mjl~m'tJilHll'IJl1~fl1111l~ :::fl'tJUll:::. .••• 4"'" I Q,I ~il 19 20 ~ c::Il ft ~.Q 1" . ,91llflllJ CVP l'1lJHl\91l1fln1fl'lJ1H 1V - fl1~fffl'lJ1mfll'tJ'Uflnt1J1V'tJmV'tJfln Ml'In'Ul~:::M11~•
, ~ •• Q 1":' 1" .• ~ 1" ~fl1mlllll'llWI1l9l1lJfl1~ Ml'Il~'Ul~:::M11~fl1~ '11CVP tl'1V'tJfl'tJfl1~'11transesophageal Doppler l'U, . .
~lhvM'tJfl1~~Wlll.,j'll9l::: lYml1fl20 ~illVVi'hi'i'Ufl1~~1l9l1lJ lllV CVP jJfl1~1l1'l'Inlh1'UtJ~lJl\U
~l! ~flil l1ril~hn9l1lJili~'tJmllJUVlfl~N 1'Ul'lm lfl1~ tiYV*i9lM~llflll:::Ul'11fl'li'l1'U(p~O.24) U~• ,.. , to' ' ,..
~il1VVi~1l9l1lJlllV cVP jJflnYl'Ufi1Vill'Uflil liflfl1~ffmnft!lL1'I'Ufl1~H cvp LY1lJ1l1'l'Imllhwi'mm:::fl'tJ'lJll~ cvp > 5 lJlJ.tJ~l1l'1~:::Mil~H'U1V~111fl1~~lfilltJllfllilV'9119 ~'tJil H'il1V~111• • •flmnn:::1~A',V CVP ~'tJili9l~yhfll~tJ~flcilVl'IllJl~m'h~1'UMt~lfli11'U 31'UmfllJlflflil
mj lJm 'tJ'llJ
"Pulmonary artery catheter
jJ 16 fl11ffmn (l'IltJ1'U9I111~~ 4) ~~tJ~:::tjhml\'lJlJ~ PAC ~lJHl\flni'mn1'U'lJ9l~ jJ
~1'U1'U9fl1~ffmn111fll~ffm1l1'U~U1V 1~1l111hM~mhfiIlMlllJlltiilJlll92N9 3 fll~ffm1l1'U -
19
~ihm;'ll1tJnmJ~ijml1Jl~tJ~l!~". '0.31 3 m~ffmml1'1M''l!l91~~1'hJl2.J4 2 nnffmn i'U~lhtJ~
d'J'UALi/ARDS".36 I m~ffnEl1'1'U~ihtJ11'1'1~~1J1l1111"15 m~ffnElltb:aiJ'Ul'tl~tJ1JLl1tJmmnn, .
VlltJ'1'UNihtJl1'1riPAC"-".30-)8i 'U~1'U1'U~~mh, 9 m~ffnEl1 'l~ijm~91 ~ltlll11JltJ'lJMI'll1rr1lY'l{• . ,
"1.Q n 24 :21-)1 35 )1 Q ,<:I & ,.....cI ,oCI ••••
m~ 11111I1tJ'U'l11JPAC.. .. Ul1::1Jl'YW~2 nnrrnElll'V1l'U'U'l1'YllJ111Jf-l1111'l!lm1m~, "
liYtJ:li1'l'O.31 Ilm1m~ li'YtJ:li1'l'hjijmmH,tJ'UUUM '1'Um~ffnElll1 i~ijm~ 91~Ltlll11J1tJ'IJ!l~nn'1M'
•lYl1\11'l11J'Yll1tl1lY'l{m~ 'l11(1l1tJ'U
~'dd d '" )0 • 91' di"i'Uf-lU1tJ'l11Jml1JllYtJ~lY~'V1l~rrl1tJnn1JShoemaker UI1::mll:: 'YllJ11f-lU1tJ'l1'IfPAC.' .protocol ijll'l~lm~mtJ~ln11 PAC ~LiI'Un~1JmlJf)1J (4 UI1::33% ;p<O.OI) Ul1::CVP+PAC ~
lil'Un~1JmlJf)1J (4 1m:: 28%; p<O.02) I~Wn~1Jfl1lJf)1J'IJ!l~CVP 11l1::PAC 'l~U'ln';Hn'U
m~ffnEl1~~mh1~::ijm~irilY1tJ PAC i~U';ri!l'U~19l'l Ul1::PAC protocol ~::Yhm~i'nEllri!l'U~
~::ij!l1tJ1::<i'lJIl11111>1tJ'YllJ111l11::umn~!l'Ui 'Un~1J PAC protocol 'l~U'ln';H ~lnn~1JmlJf)1J
miH 'I~~'ll1JnnffnEll i 'U~U1tJffl1tJnn1J l'ItJ Sandham" 11l1::mll::'YllJ11'l~ijml1JU'ln';Hn'U i'U. ,
1l'l~lnmfftJ911'li~111l::ii' PAC 11~!l'l~ (7.8 UI1::7.7%)~~ '1l1i'Um~ffnEll~~n~11ijm~H'
U'U1'l11~uiluiimh~i''IL~'U Pearson UI1::mll::21'YllJ11i~ijml1JU'ln';Hn'U i 'U1l11::Um n~!l'U
UI1::Il'l~lnmfftJ911'l'1'U~U1tJ~111m~ ~19l'l1i', i ~ u';m~ '1~ PAC ~::Lli1Jnmh i ~~ltJ i'Un1~
i'mn mh~ i ~~'l11Jm~ffnEll~~mh1 i~ijm~ till1'U>11tlll11J1tJ'l1H'Yll1tl1lY'l{m~i 111111tJ'Ui''Il~'U
m~ffnEl1 PAC i 'U~U1tJ~~19lm!l!l!l{.I'l'IJ!l~'li!l~l1!l~i~11lJml1JL1'ln';1~'IJ !l~Il'l~lm~
lfftJ911'l"." ~::tJ::11111'Utl'U'1'U'l!l91~ Ul1::~::tJ::111l1'U!l'Uh~'YWllJll111~!lll'l~ 1nmfftJ911'l• •
mh~ i ~~mlJm~ffnEl1~~n~11 i~ijnnlll~ltlll11JltJm~ iM'lY1~U1m~ffnEll'IJ!l~ Joyce UI1::mll::"
m1::umn~!l'Ull1tJl1ti'~m~ ~19l>111'1i ~~\'U 111~ln'l~'U i 'U~U1tJ~ijm~ l1m'U'IJ!l~11'1i 11M'!l~~ltJ
~1~l>1tJi~l~tJ1nlJm~iM' PAC 11~!l'l~
m~'1~ PAC Ihl1i'lJm~I'l~tJ1J~U1tJri!l'U~191>1(Preoperative hemodynamic optimization)Q ~ ..., ",', •• , ~ d 2l 27-29 .., "." " 1 ~ 311J4 nnl1nEll'lf~'V1l ,'U~u1tJ'l1f-l1'l'l1111!l>1Il1!l>1. Ul1:: 1 m~rrnEl1l'U~u1tJ'IJ!l'l:: 11nl1n 2
.d 27 JI ,"'" .,J..,.J' i "1 "'" 21 • C'I 91' ..ii" dnnrrnEl1. 'YllJ111Jf-l11'l1>1'IJ'U'Ul!l'lf~ Berlauk lm::mll:: 'YllJ11 I'U~U1tJ'l1 'IIPAC 1Jv ' .•.• • .•... .•.. 'jI 4 •••• Q ..::1 .••• V"
1111::Ll'11~n'l1!l'U~::1111~U11::1111~f-l1'l'I n 1~1l>1'l'U'IJ!HtlY'Um!l>1UI1::!l'I ~1n 1~llYtJ'lf1'l'U!ltJn11n 111J)J ~ i ~ d ~ i ".'1 "d" 1 ~ ,~.mlJf)1J Shultz 11l1::mll:: 'YllJf-ll1m~l1nEll'Ul1nElIll::l>1tJ1n'U'U~u1tJ'l11J'IJ!l'l:: 'Ylnl1n !ltJ1~l~n
~ ,''' d 23 28 29 • Wi 'd . i "''l11Jm~l1nEl1!ltJ1~'U!ltJ3 m~rrnEll . . 'YllJ1111J1J1l111JU'In'lH'Ul1n::umn'lf!l'U~::111Hm~
~191>1~::tJ::111l1'U!l'Ui'U'l !l91~ ~::tJ::111l1'U!l'Ui 'Uh~'YltJ1lJll111~!l1l'l~1nmfftJ911'l 'l~111l::'1~
PAC 111!l'l~<:t YA'l 16 I II) ,.<:5 • C11 vl'U~u1tJ ALI/ARDS Richard Ul1::fllll::. 'YilJ1111J1Jfl111JU'lnVll~l'U1l11::U'l1m'l1!l'U
11~!lm~lfftJ911'1i'U~U1tJi~111l::ii' PAC 11~!l'l~ nnffnEl1I'ltJ ARDS network JS'YilJf-ll1
m~ffnElli'Uu'U1'l1Hli'itJ1n'Ui~11~::'1~ PAC 11~!lCVP U';~U1tJ PAC ij1l11::Llmn~!l'U1Jlnn11
'1'U'l!l91~~11JRhodes UI1::fllll::J4'YllJ11ijllm1mnfftJ'li1'l m~ In'l !l1tJ1::<i'1J1l1111Ul1::
~::tJ::111l1'U!l'Ui'U'l!l91~111!lh~'YltJ1lJll1'l~U'ln';1~nm::111Hn~1J~H PAC 111!li~ nnffmn
~\,npG~n~t.~&wn.~!;e:M.LlJm~G~M.\l.LIlLnM.Ht"'\'tLG"'~"'t.",L~ ~!;e:~~!1
tLULt~9 Ut11tLG~,9 "'\, \l.LIlLnM.Ht",\,t.~LRUk~W\,~L\l.U:;~:;t:;\l.n~!;e:(!~t.~~~",l-G~\l.tl(!
~W\':)Vd ~\,tLUL~IlM.L£t.\l.M.'rt~&\,t.!l:;t.LlJUL&ULlloL~"'l;m~M.tLULG(!~Ut.~~llkM.L~• •~\,~LpG~n~!;e:~t.!"tLUG~M.Ltl tL.Il.~ \,tLU",\,~LrtM.L1P
•h.:; t~WI,nL~M.1LRU~tLUrtL~~t \,np G "'.vw~,nIAJ,I~",\,LRU~tLU\l.tl~\,,,:;ml!:;\l.nAMIIlH ~Gn.
•
0<::
21
\1ll~1~~4 Ul'f~W'Hlfll1ffml1UUU RCT 'IJ!l~fm1otil'fl/JPAC ~mHlfll1i'mn
1~11JlJI i'mn
f11>i'J
fll~ffml1
(~nnu
l'fmUU)
~lU1U I n~lJffmn (~lU1U)
~"b/J~"b/J fHl~l'fu1~ 1Ufll~ffmn fll~ n'b'li lJl/Jfll ~
.~ d
~l'1fllnmn!lU '1 ~1'1~!lli~n
Vll/J
Shoemaker I 88
WC" (I)
~:: h'lOHn I f1wi'J
. ~mflfl
mllJl~/J~ 11unnHlfl~!l~'li1/J
l'f~'IJ!l~fll~ 11i1/Jl~•
l'1f1liml~l/J
ncilJ I : 29%•ncilJ 2 :•2,9%
l'1f1lifl~l~l/J.nlllJ 1: 23%;
n~lJ 2: 33%;
n~lJ 3: 4%
vl'1'JfIl1:al'YIm'b'6U
11l'111u169lQ,1Il~/J(SO):
n~lJ I: 1L5 (1.7);
n~lJ 2: 15,8 (3, I);
n~lJ 3: 10,2 (1.6)
9V", 9mn !'Iflm!l~'If1/J1i1/J!~.
'1Ju~n~l~
'" CIo" ~fIl1::Um n'b'6U 'Ii1'1~~l~ fI
n~lJ I : 11%
n~lJ2: 10%
lIln/J (SO):
n~lJ I: 4,6 (1.4);
n~lJ 2: 9,4 (3,4);
n~lJ 3: 2.3 (0,5)
V02: 12G--140
002: 40G--550
1'Ii
n~lJ 2: CI: 2,8-d -,
3,5 l1JUl'YI-lJ ';
d -,
lJI'1JU1'YI-lJ, ;
d -,
lJI'1JUl'YI-lJ ;
n~lJ 3: CI>4.5;
002:>600 lJl'1Jd -,
Ul'YI-lJ ;
V02:>170 lJl'1Jd -,
Ul'YI-lJ
1'1i
li~nVll/J1u1!l91Q UI'1:: 11'1iv ~
fll 1::U'm n'b'!lU'liI'1~
li~11fll~Vll/J 1U 1!l9lQ
lun't UI'1::~::/J::111'11
'!l91~1
n"1:~n
1!l91QI
~"h/J~jj
n~lJ I : 11J1otiPAC (35)
n~lJ 2: PAC (35)
n~lJ 1 : i1J1otiPAC (30)
n~lJ 2: PACUI'1::normal
goals (30)
n~lJ 3: PAC UI'1::
supranormal goals (28)
70
RJ" (I)
Schultz
22
llll:: 5 : 0
1ull~nril~
flR11mv
mv
n~usJ, 2,
(tllJ):
iUllRnril~
';lsmll: n~lJ I < n~lJ 2 <
n~lJ3
1::v::nll1 1lJ m.
iUllRnril~tilJ
IR5VlJ smn
~1~'J
fl11::11lnni'VlJ ';1
smn1lJ m. flmWllV
iV~~1
~Wi~M11~
n~lJ I: iuH PAC (28);
n~lJ 2: PAC (86);
n~lJ 3: PAC+ Sv02 (66);
n~lJ 4: reassigned PAC
n~lJ 5: reassigned PAC +
(33);
".'1flu1V•
226Pearson
Isaacson
Joyce
WP" (I)
102
40
Sv02 (13)
. i '9 "nlllJ 1: lJ l'lfPAC (53);
n~lJ 2: PAC (49)
n~lJ I: 1u1,r PAC (19);
n~lJ 2: PAC (21)
mn1lJiv~~ at';l
smn 1l1l::flml~lV
"11n::llln n'lfVlJ'I11~m 1
'Hlv1~nll11lJ1v~~
at 1l1l::flmlR1V
iUll~nriN
n1l11lJiv~~, Ul~V(SD):
2.1 (1.0) vs. 2.7 (2.6)
n1l11lJ m.s, Ul~V(SD):
9.4 (6.8) vs. 10.2 (8.4)
iUllRnriN
iUllRnri N1 ::l1';h~mllJ•
ncilJ3'I'. .,n~lJ 4: I.
hillflnriN
~llJ1lJR1V
(tllJ):
n~lJ I: I;
n~lJ 2: 0
'JillM,il~ullnll~lu
(flll):
n~uI: I;
n~u2: 0
I
l\il~V1J i'mn
~1.1~
23
Bcrlauk JF 89
"(I)n~1J I: PAC 12 i,11J~
titJU~l.1~ (45);
n~1J 2: PAC 3 i,11J~
titJU~l.1~ (23);
n~1J 3: 'liH PAC (21)
"" • Q.< 4l1MH1\i1~ 11l1tJ~mtJ\iI
.IU UI1~VmlmV
n~1J I UI1~2 :
PAOP<15 lJ1J.
lh tJ'Yl
l1\i1tln~u'Yl~n'*tJu
mi~~l.1\i1 : 17.8 VS. 13vs.
42.9%
~~v~n1111u 'tJq;~ l\l~V
(SD):
'liU\iln~H
~l\J1U\illV
ncilJ 2: 0;,
f1~lJ I: 19.4 (11.6); f1~lJ2: f1~lJ3: 2
18.0 (12.0); f1~lJ3: 15.4
(7.5)
Guyatt G 33
"(2)n~lJ I: 'li1~ PAC (17);
nci1J2: PAC (16),
..• ~11I1tJ~mtJ\iI\ilU:
f1~1JI: 2.2%; f1~lJ2:4.3%;
f1~1J3: 9.5%
'liU\ilf1~l~
~~V~1u~'Vi.(~\l~V)
f1~1JI: 8.1;
f1~lJ2: 10.3
'liU\ilf1~H
~l\J1UmV
(I1U)
f1cilJl' 10', . ,
f1ci1J2: 9;,
24
fll/J
1'I'J111lJl/Jn17nn"iJfl 1/J•UllJ1lJ n~lJffnlll (UllJ1lJ)
HiJ1/J•
fmffn1l1
(hU1lJ
«mUlJ)BenderJS 104
28(1)
n~lJ I: PAC (51);
n~lJ 2: ilJii PAC l1ifl
PAC lrlfliimllJlill~lJ
'IlNfll1i1n (53)
hi n~lJ 2: ilJlLfln.il~
PAOP<14lJlJ. 7:::/J:::1lJiflt]j~:11l~!J(SD)
1J7fl'll; n~lJ I: 2.7 (0.2);
CI>2.8 jllUll1-lJ n~lJ 2: 2.6 (0.5)-2. l:I• 1::tJ~ ~tJ'j'V'L
ilJlLfln~N
IillJ1lJfll/J
(f1lJ)
n~lJ I: 0;
n~lJ 2: 0;
Valentine 120
RJ 29(1)
n~lJ I: ilJH PAC (60);
n~lJ 2: PAC (60)
" ,1l11:::lLm n9l'fllJn fllJ
lLll:::11l;~t.b.Y fI
'".. ,7:::/J:::t11l1'lllmfl~'ll1/J
111/J'~
7:::/J:::nil 11lJifl9i~lLll:::
hi
SVR<I,lOO~ ~ ,
dyn-1lJl'll/9l'lJ
n~lJ 2:
PAOP<15 lJlJ.
1J7fl'll;~
CI>2.8 ll.llJl'll--,
lJ ;
SVR< 1,000 dyn
1lJll1/9l'lJ'
n~lJ I: 12.5 (1.4);
n~lJ 2: 12.0 (1.3)
'uuPlnvi,~:n 11:a l't1'Hl"VU'H n~f.h,j' A
fl~JJ 1: 25%:
n~1J2: 17%
nl'll~HI"i()~;1tJl1'{lh,lllJ. <SO): n~lJ
U(J),
OQU 2, 35 (9)
I1l'111u'o;~,nl~u (SD):
OQU UO),
n~lJ 2: 8 (J)
I1nl1u 11'1., t~~v(SO);
fiQU I, 13 (2),
OQU 2, 13 (2)
ilJii
fmflm.n " ~lU1U fl~lJflmn (~lU1U)
(~lmU f'({bo•lYf.11lJu)
f'({bo•011 Lil1'11lJ10011
11110lJ i'mn
,h.il1
25
Yl10
Bonazzi 100 , ~'t~fl'llJ I: ~lJ 'b'PAC (50);
fl~lJ 2: PAC (50),
mn111
~fl11::l1'Ylm C)jtJU111~
111t~ '11110'l1li~,h.il1
1:::0:::l1lnlu1l~.
fl~lJ 2:
PAOP<18lJlJ.
Uml'l;
CI>3.0111./
1l-iUYlfl~i1~:1111~l.i'UNfl
~~'I11:::,1111~l1lJL'I11111Y1
110
'hjiJt111lJUYlfl~1~1:::'I11H
~' ,IlJUl1flm~:
Yl10(t1U):
flrilJ 1: 0;•
Rhodes A 201 fl~lJ 1: 'hiti' PAC (106);
fl~lJ 2: PAC (95)
mnJillJlJiJ: 011nmO~
281UIlCl:::~
fl11:::UmflC)jtJUNil
'VJ~OlJiJ:1:::0:::l1mlu~ 4 ••
l!JC)j~Ull:::1~, 11lJ i1~
"'" -2 'UTl'l-lJ ; fl'llJ~IH1:::0:::
SVR<I,450 111l11U1~.median OQR):Q "'" 5 tdyn-1U1'V11C)jlJ. fl'llJ 1: 12 (9-16);
002 >600 lJll./ fl~lJ 2: 11 (8-15)4 2
UTl'l-lJ
1lill~n~H:
SOFA score, 1~11U,ARDS: 1liu
mlllll~n~HH ••1iHmi~
I1nll,,1n91Q, U>UJ1" (lQR): mi~
I: 5 (2-12); mill 2: 4 (2-10) I1nl
i" 7ft. U1UjTU (lQR):
mill I: 13 (5-32);
n~~ 2: 14(3-32)
1l-iUYlf1~H:
~lmumO
('Yo):
fl~lJ 1: 46
(47.9);
f1~lJ2: 50
(47.6)
ft~U~lpl.::m~UltllflL
l ~It f.l.UlIl.lft,\l
::WtGBW ~ttll.ttt6::W......... ...."W~tflL ItLu@t-tflL~llJU
(~"8)O"~:l ftllU,
~(~"8)n:I ftllU ~t Illll.llt!!,~@~Hl0
:~tlllll. J[,tftLll.llJU::lJll "f.l.~f"& • f"
Ilt!l'~@~H1N[lL~llJU ::lll1ii!!;@Lttt llJtl::Il::~
(6~) (n I) n'l :l ft~U ~t tll.nt6::WlllJ[,t~ ~ ~661 :l ft~U ~(9"1I) vi :1 ft~U flL~llJU ItLu@/-mu
~(l9)80l :(as) 1l~t11"f.l.~tttLllU tlJll.lrtlJ::tlltB ttt~ ~ ~:1 ft~U:(%) (0"0I) 6"11 :l ftllU 06 ::lJ11vi ll.IlLIllL~It@smrv@m,
f" ~ ••nUlLQ'Illlll ~(I"0I)9"11:1 ft~U :Gllll~ttlJH Y~tAJlol•
L~Ill~,(ep-8l :(as) 1l~t11'ii!!;BLtttUltl n1-8l UlQU@J[, (~££) ::>Vd:l ftllU (9£)"" 0
:~L~UltllflL :HItUltllrtL (J[lL (JflL ~IlLItL~Ill~:GUrcli[l.lJH /ii!!;BL ~(Iv£) ::>Vd~tflL :1 ft~U 9L9 ::>pJelp!~. ,
ItltlH (n£1.LllY~ ,Illit lfW£ rcll~llll Iltr,t~ r\tnL~)•.
L~ItBGltlJH L, n@lRU~tLUlJH ~LUIlLrcIl.LkU tLU LRU;!~LUttt~t ttY~lJH Iltr,tH (tttnL~) LRU;!rc~u r\tt\l~ LRU;!~LU~ , ~ ~ ,~
ft~U~lpt.:::t rq~U\l'un009< lOU
BZ~Gl~lt~ll
nlH~U~ll~L
~(89)9P( ~Zn~u
~(99)(((: I n~u
:(%)ntl\l~
"UnlGl~lt~J.l
:H~U~ll~L
nO~l ,I::U1I9 al~ltlJl,ii
nl',~,,~u~l1rL(n) BL :Z n~u
~(n)LL :1 n~u
:(%) nttU~
',,,nLGlO
ltM9 ;~l~U~I1~l
(OL-Il) Ov:l rt~U•:(J 9-£l) 1'£ :I rt~U
'nIbIl flLliralnu f1.1.LllU
(O'll-C» 0'11 'l rt~U
:(£'ll-n) I'll :1 rt~U
:nlbIl f1.Llirnrt~'ii(!;@Lf1.1.LllU:~L~Ul6l1ftL
t'l~U16l1ftLlPUA llltn~::UIl16L nu.1
al.uull\O~I~~tlU ::t~t'~~~n~ml
Lfo tUH.ln,\H\lt~ Ull~l\tt!iQj:lftl~U
~(Sl-O 01 :z "~U'(SI-OOl:1 n~u
:(lItlil mKau!, "", nLlutl:H~UlillflL
~~lt1JOZ:I>'MH
~u.IH~'lUmL<dvw
,rt.l(,/l!ln~
UhPO~tr'I>'MhS
',_n'!llnru 1,'«1:>~lAGt~'nn 81>dOVd
:z n~u
'::[email protected] ii(!;@t
f1.1.~Ll6U l61' ::1l11f1..\;8l
LWLl6L~l6@:rtiJ~l6ttllH:" 'I:l.....,.
'Mtf1.1.
(!ftt ~Ll6L~l61':(:iJrtli[tllH
f1.1.f1.@~Uutl1::tW::lll1
~Ll6L~l6@:rtiJ~l6ttllH~ ~ ~
:'M~ f1.1.
~Ll6L~l61':(:iJrdi[tllH
WJ,'llrtLtll:-
(!~~tf.\~
/ii(!;@t
(61,)::>Vd:l
rtiwUl, '
(L66) ::>Vd :l rt~U
:(L66) ::>Vd Jl.1.rt1'I rtiw(Ii I '" I
IvaI
\7661
l, f1.@LfWULUllH~ ~ tLU
~tf.\~f1.tf1.L~•
(f1.l\LllJ,'l
f1.tf1.L~)•LR.U~tLU
28
liJll1lJlal111 - .•fl"nU1nlJl!l\J '1
ma
Binanay
Cl7(26)
433 n~lJ I: i~H PAC (218); itlCilgt
n~lJ 2: PAC (215) NYHA IV
11,t~li'lJlmn
fllllJjlJlJiJ:
1mtl.,~i~tl~t\J nt., .•
1:I1,l~ 6 L.,tl\J
fHlYl~al1ii:• •In llJftllJ11tl'\ltl~1111
tltlm'hli'~l11a
natriuretic peptides H":
v'\Itll;j" PAOP<15lJlJ.
tJ1tlYl;
CVP<8lJlJ.
tJ1tlYl
i~HYln.iN:
'1iHYln.il~1:l1'il~ n~lJ
i1iHYln.il~:
~1\J,\J1\J11
i1iiA'!l~t\J
nt.:
n~lJ 1: 133;
n~lJ 2: 135
i1im,n~R ~1\J,\J1\J~i~ i1iHYln.iN:
Hlfl~!l~'1hamaMIJ~ 28 60 day VYl11
Wheeler 1000
AP "(42)
n~lJ I: i~toti'PAC (487); itlCilytij
n~lJ 2: PAC (513) ihym
acute lung
injury
da
~(UnWI'lf,.,
fHltJjlJlJiJ:VYimlla~ i~jj i~jj
601\J;
fl"lJ9ialJii:
!l1a,:li'lJLl1'"
- d,\J, m"a (SO):
n~lJ I: 13.5(0.5);
n~lJ 2: 13.2(0.5)
- vi' ,!l,a,:"lJLl1",: lJH.,nm~, ,
1:I1,l~ nlllJ
mao
n~lJ 1:
26.3%;
27.4%
29
Mixed (SvO,) UU:::Central (ScvO,> venous oxygen saturation
ihVlv~ 6 fmffmll~H.y1UU~ m~ 'JUri~lHln<iil~ulvi{lffmmHlm :::'I'1mi{lm~~mll'" '9-4'"1'"" .1 Q Q •• ~ '\.Jastremski 11l1:::mu::: ~1lm l:::m'll1m:::'I'1Ulll1:::u~:::ff'l'1lillWH'I'1VUnU~1fl1'J{l~m~ 'If
svo, '\u~':bv 1{lq;~{llQ~m~1I'YiU11'hjiifl111lu~nvi 1~'JlH~lU1U m1U flU1U1{lq;~ 't11mi~~l
•~{l~;W ~:::'t111~'l1~2 n~lI11vilJl~~:::V{lll~u'l~'\Ull~'J()~u~:::il'l'1illll'Yill1VUnUmll ri1't1~U1U
i{lq;~~111Gattinoni Ul1:::flf.ll:::40 1ll'YiUfl111llL~nviN'J()~l1n:::U'I'1m~{lU 't11{)li~~1m~lilv;1~Lrl{l
lmVUtl1Vm:::'t111~m~~mm:::~u SvO, 't11{lCardiac index '\U~:::~Ulj~ (supranormal) nun~lI
mU'JlI•• ~" 414''\. 1 •.'1 ,~~ 'l .• 1 '\. , -~1I3 m~l1mn .. 'IfSvO, Ur;jU1VH1~~'t11~Ul1:::'t1l1{l~Il1{l~~V 'lHnrn'l111Jl't1l1lV
•n!lU~.h~'l~ mm :::~USvO,>65% 'YiU11ill l1'l1ll1:::um n~!lU '11~~:::'t111~Ul1:::'t1<i~~1.y'I 't1l\{)'I4 41 22 'Ill ,.,. ., <:l.... 0 ••.• '\ ~ ••
1l1!l'l PearsonUl1:::t1f.ll:::'YiU1111111f1111JU~nm~!lV1~1JUVff1t1'l!U~:::V:::L1l11U!lUL!l'll~
11l1:::11mn~!lU't11{)li~~lm~tilv;1~'\U~U1v~.yhm~~~~11l~1V PAC, SvO,.PAC 't11!lCVP
"I" 4' '\ 1lJV1~ 1n~11l Polonen Ul1:::t1f.ll:::~lV~lUm~l1'l~:::v:::L1l1l um~U{lU H'YiV1'U1l1
11l1:::umn~!lu"'!li~~1.y'l'\ U~U1V~1~'l1111~~ 'l~l11m~~~mm :::~U'J{l~SvO,Ul1:::~:::~U
Lactate '\ULftMI'\U8 i111J~lmm<i~~1~'l Ul1:::m~ltm1:::M~'l9111lvi!l'lU'YiU11L~1It1m1~!l'l;'Yi
'\ .. ""~".U 6 L'l!lUUl1:::1 u't1l1~mmn1ll'l1V• ~ '\. "'.>1 ~.." ~.I..· 1.ff1lnunn 'IIScvO, tUUlU1't1l1lV'J!l~m~~n1ll1lm~ftmIlUUU lu'JN't1U1'l1Vm~ 't1
• • •ff1~U1mh~'l1mh~11 (Early goal directed therapy) '\u~u1vl1iim1~'lLo\i!l!lVN1UUH't11!l.jJ'!ln
River Ul1:::t1f.ll:::4'WU11t191~lnmilv;191l1'll1~lun~1I~U1V~iim~ '\~ ScvO, L~Ul{j1't1l1lV'J!l~"'" .co ••.• • 0 1"~ ...,o<:S 1.
m~V1'lVll1J(30.5 11l1:::46.5%; p < 0.009) ~lnm~ftn1ll~~n11l1'1'1l 't1u~~UU1Jm~ 'IIScvO, 1Il
J.. 1,.. . '" • l' ,.l1'lll'l'1USvO, lIln'JUlU!l~~ln 1I11f1111l~11U'U~!l~fffflVUl1:::'Vi'U11~:::~U'J!l~SvO,Ul1:::ScvO,. .iifl111l11Vlnvi1~nu'lllLfiur!lVl1:::5 ti'lm~'t1l~lnri1t\lliv~lnm~~mft{l~'t1l1lV '1 t1~~ Uvi!ll~ii
•, ~... '" .• ~ .• 44'" ~ .• 1. '\.fI111l11Vln91NnUm~!lVl1:::10 't1lmUUm~~~LWV~t1Hl~V1 u~~UUlIllU1 UlIl1l~ 'IIScvO,
J .• '\. '" ~ .1 • ~ '\ '\. : '\ .}' .1Q ~Ql1~U'I'1USvO, lIln'JuUl1:::lIm~ 'II1UllmUu~ff1t1'l! um~ 't1ff1~U1 Ur;ju1Vmllll1l111Nu{JU~•.Q 4 4546
lIlVl~jj1U'J1Nm~91~l'll!l111UH .
u'Ill'qtl
1i~llU'tJ~~Ull~:::iiull11 ,r1J'J!l~m~ i ~ff1V'J{l~PAC ,r {lVl1~{lV1~ii\!vri1il'l!~V111lUl1:::m~ffmll
mnv 'lll1i~~'Vi1.J':hm~1~ PAC 'lll'l~IU~VllllUll~Hllm~~n1ll llvi~~ri1ti'l!~fI1~fhu~ii{l~ •. 'I ''I 'JI.l ••.. '<:l 'J1 4 'I . ,...dlll IQ'" ,~,
Hl1mnmll'J{l~r;jU1V 1I ~'JunU111lm~h PAC m{l 1I ul1:::nni'J PAC 'I'111l1l'J{lm'llU1~:::o " Q 'JI J 47'" ~ .;. ~ <:l .dt 4";'1. Q ••
'I'1li't1ln~l1lVU'I'1m'll!lllllln'JU !lnmlll!l~~ln PAC lUUl'ViV~lm!l~lI{ll1'IIiUm~91~m1J't1~!l
l~n:::1~ ~~,fllHl1m~~nll1oJl~:::~ununnllUllHl1~1~~ln PAC lIlnn11m~iim~iri PAC
.• 'I ..• .• "'i. "'~, , '" 'I 'I."''' -~ •m!l 1I Ul1:::lU!l~~ln't1l1lV'1 m~ftnlll'l'1 't1Hl1'1'1LlIUVlflm~!Jl~IUll tl ~'I'1111U1't1l1lVm~i't1m~i'nlll(targct or goal of treatment) ~'hjl~uWml1ft 11l1:::ii't1l1lvm~fffl1lliutJ~~UU~'ViU11m~ 'lM'.
30. ,lYU\11mh~ihill',HJ1V'IJ!l ~fll1 i'mn 1U111l1l1~1nflllll ~11fll~1ihm ~ilVWln1or'll il~11flmh ~iJ
irv~hii't)J4) .J~,fu1lii1~::H CVP 111ilwedge pressure ~ln PAC 1Ufll1~flfl11J~lhv~::vi'il~
l'li'm1fllu 3 a~.iil1t1if~~Mn~1111li'1'li'Nvi'Uflil
1. nU1fl~fi1nvi'il~ (correct measurement) 111JCi~nutli'lJvi1m11J.J\ll~1Jvi'u (zeroing) fll1'IJ~fl• • )I •
9i111tl1n1Ul1~~1111,n~I'mnmhul1ilfllVlvu1 tI l11nnU1flilflOlJ1Jl1'Ju1 t11~V1nl1~~1l1'nu
i'mn~\1nvi'll~1~
2, nUlltll1lo1l1~\1nvi'il~(correct interpretation) iJm1lJff1ii't)JilOm!~ m1lJ'M"hvi'il~111nU(hu
fl~um11Jiiulwlh~lfl lY11J11011tll1Io111'V1Nflih1n~ln'li'm.ll1l1l1n3 ilON~ln PAC 1~lln fl11lJ.JUI I .o'J , q
nUlY~1oI1Ull1ilfl(cardiac output) 1111~fll1'IJUmVililn'lfI~U(mixed venous oxygen)'10 .... .d'" .ely ••... ..dyd
3. fll1mlol11 t1'111fllnmn'VI\1nflil~ (correct application) O~lllJfll11fllll1~fllmtll1lo1l1'V1\1MIiJ~n
'l11J l11niJfll1\111 t1t1ilu~~ilfl IoIl1fll1i'mnO!l1J 1li~1'liunu
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