功能性血流动力学监测ppt.pdfVIP

Functional Hemodynamic Monitoring and Management A practical Approach Daniel A. Reuter Center of Anesthesiology and Intensive Care Medicine Hamburg-Eppendorf University Hospital Hamburg, Germany Euronaesthesia 2006, Madrid, June 4 Early Optimization of Hemodynamics improves outcome Kern JW and Shoemaker WC Crit Care Med 30: 1686 – 1692, 2002 Metaanalysis of hemodynamic optimizaton in high risk patients Rivers et al., N Engl J Med 345: 1368 – 1377, 2001 Early goal-directed therapy in the treatment of severe sepsis and septic shock Goals of hemodynamic Management 1. Optimizing Stroke volume /Cardiac Output: • Measurement of SV/CO 2. Optimizing Preload: • Measurement of Preload • Assessing Fluid Responsiveness 3. Avoiding Fluid Overload • Assessing Pulmonary Edema Preload Optimizitation as primary Step to optimize SV/CO Preload low (too) high CO ? CO ?? ? Macrocirculatory ? (Macrozirculatory Dysfunctions Dysfunctions) ? Microzirculatory ? Formation of Edema Dysfunctions ? Microzirculatory ? Organ Failure Dysfunctions ? Organ Failure Ventricular Function Curve Stroke volume Preload Stepwise Fluid Loading to optimize SV Stepwise Fluid Loading to optimize SV