Introduction

Adequate blood circulation is vital for

maintenance of adequate tissue metabolism

Shock is a life threatening condition in which

blood circulation unable to transport oxygen
adequately to meet tissue metabolic need
(International Consensus on Hemodynamic Monitoring
in Shock 2006)
 Haemodynamic

What is hemodynamic?
Hemodynamic is blood flow within the
cardiovascular system, it reflex cardiovascular
performance
Dynamic state, have an autoregulatory mechanism
Multiparameter
 What organ involved?

Organ involved in hemodynamic are the heart, the

vascular bed and the lung
(Cournand dkk, 1943; Finch dkk, 1972; Shoemaker dkk,
1973)

Nerve system, hormonal system and metabolism

What for?
To maintain and integrate all organ within the
body
 Hemodynamic parameters
Based on direct measurement
Parameter Abbrev Unit Normal
Heart Rate HR bpm 60 – 80
Central Venous Pressure CVP mm Hg 4–8
Right Atrial Pressure (M) RAP mm Hg 4–8
Right Ventricular Pressure (S/D/EDP) RVP mm Hg 15-30/0-5/2-6
Pulmonary Arterial Pressure (S/D/M) 15-30/10-
PAP mm Hg
15/10-20
Pulmonary Artery Oclusion Pressure/ PAOP/
mm Hg 4 -12
Pulmonary Arterial Wedge Pressure (M) PAWP
Left Ventricular End Diastolic Pressure (D) LVEDP mm Hg 4 – 12
Systemic Arterial Blood Pressure (S/D/M) 100-140/60-
BP mm Hg
70/70-100
Capillary Arteriolar Blood Oxygen Saturation SpO2 % 96-98
 Based on calculation/derived value
Parameter Calculation Unit Normal
Cardiac Output CO=SV x HR L/mnt 4–8L

Cardiac Index CI=CO/BSA L/mnt/m2 2,5 - 4

Pulmonary Vascular PVR=PAm-PAWm/CO x 80 dyne/sec/cm-5 30 - 100

Resistant
Pulmonary Vascular PVRI=PVR x BSA dyne/sec/cm- 70 - 180
Resistant Index 5
/m2
Right Ventricular Stroke RVSWI=SVI x (PAm-RAm) g.m/m2/beat 4-8
Work Index x 0,0136
Systemic Vascular SVR=MAP-CVP/CO x 80 dyne/sec/cm-5 900–1400
Resistant
Systemic Vascular SVRI=SVR/BSA dyne/sec/cm- 1700-2600
Resistant Index 5
/m2
 Left Ventricular Stroke LVSWI=SVI x (MAP- g.m/m2/beat 40 - 75
Work Index PAWm) x 0,0136
Coronary Perfusion CPP=Dart – mm Hg 60 - 80
Pressure PAWm/LVEDP
Stroke Volume SV=CO/HR x 1000 ml/beat 60 - 120
=EDV-ESV
Stroke Volume Index SVI=SV/BSA ml/beat/m2 30 - 60

Mixed Vein Saturation Sṽo2 % 65 - 75

Oxygen Content Cao2=Hb x SaO2 x 1,36 vol% 17 - 20

Oxygen Delivery Do2=CO x Cao2 x 10 ml/mnt 750-

1000

EDV & ESV value produced by echo

Hemodynamic monitoring technique
Left/systemic
Right/pulmonary

SpO2

Artery

CVP
BP
 Placement of SGC tip

SGC

Right placement of
catheter tip
Pressure wave form encountered during SGC insertion
 Hemodynamic parameters and it’s characteristics

Circulation Source
Parameter Indicator Influencing factors
Left/ Right/ non
invasive
systemic pulmonary invasive
HR ? inervation, hormonal, resistant, √ √ √ √
preload, contractility
CVP preload capacity, volume, resistant, HR √ √

RAP preload capacity, volume, resistant, HR, √ √

contractility
RVP preload preload, contractility, resistant, HR √ √

PAP afterload CO, resistant √ √

PAOP/PAW preload resistant, HR √ √

LVEDP preload preload, LH, PVR, HR, after load

BP afterload CO, resistant √ √ √

Note: for continuous intermittent purpose echografi /

doppler substitute invasive method
 Circulation Source

Parameter Indicator Influencing factors

Left/ Right/ non
invasive
systemic pulmonary invasive

saturasi
SpO2 diffusi gas, asam-basa, V/Q √ √
arteriol

CO pompa preload, kontraktilitas, HR, tahanan √ √ √

CI CO, luas permukaan tubuh √ √ √

PVR tahanan metabolisme, ventilasi, organ √ √

PVRI PVR, luas permukaan tubuh √ √

RVSWI kontraktilitas metabolisme, preload √ √

SVR tahanan metabolisme, ventilasi, organ √ √

SVRI SVR, luas permukaan tubuh √ √

Note: for continuous intermittent purpose echografi /

doppler substitute invasive method
 Circulation Source

Parameter Indicator Influencing factors Left/ Right/ non

invasive
systemic pulmonary invasive

LVSWI contractility metabolism, preload √ √

CPP perfusion SVR, preload, HR √ √ √

SV volume preload, contractility, √ √ √

resistance
SVI SV, BSA √ √ √

Sṽo2 mixed vein CO, O2 extraction, acid-base √ √

O2 saturation
Cao2 kandungan Hb, saturation, V/Q √ √ √

Do2 supply CO, Cao2 √ √

Modul Created By.

Note: for continuous intermittent purpose echografi / INKAVIN
doppler substitute invasive method
 Hemodynamic evaluation as a guidance to patient therapy will
only useful if followed by appropriate therapy/intervention

Clinical application based on hemodynamic evaluation

BP High Low

Dx vol>/<,SVR>,LHF,hyperdinamic, vol.>/<,SVR<,LHF,RHF,PH

Rx diuret.,venodil,inotrop,art.dil.,analget.,sedatio art.consctr.,inotrop,vol>,art.dil.,PAdil
n,β block,vol.>
VFP High Low High Low

Dx vol.>,SVR>,LHF hiperdynamic,SVR>,v vol.>,SVR<,LVF SVR<,vol.<,RHF,PH

ol.<
Rx diuret.,venodil.,inotro vol.>,art.dil.,analget., inotrop,vol.>,art.const art.constr.,vol.>,inotro
p,art.dil. sedation,β block r.,art.dil. p,PAdl.
SV High Low High Low High Low High Low

Dx vol.> SVR>, Hyperdin SVR>>,v vol.>, LHF SVR< vol.<,

LHF amic ol.< SVR< RHF,PH
Rx diuret., inotrop, analget., vol.>, art.constr prn:inotro art.cons vol.>,
venodil. art.dil. sedation, art.dil. p,vol.,art. inotrop,P
β block dil. Adil
Thank You