Noninvasive Cardiac Output Equipment

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Non-invasiveCardiac Output Equipment
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• Cardiac Output
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CO (HR) X (SV)
(??? CO ?????????? 4-8 L/min)
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?? 20 ?????? 2-3 ??????? 2550
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CO measurement
Accuracy
Reliability
Reproducible
Continuous
Safe Ease of use
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CO Equipment
Pressure pulse contour analysis
Partial CO2 rebreathing (Indirect Fick Principle)
Impedance cardiography
Doppler shift frequency
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?? 20 ?????? 2-3 ??????? 2550
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CO Pressure pulse contour
- Less invasive or
virtual non-invasive
- Continuous (beat to beat)
- CO Estimation relative CO, absolute CO needs
other cal.
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Pressure (Flow) x (Resistance)
MAP (CO) x (SVR)
MAP mean arterial pressure CO cardiac
output (flow) SVR systemic vascular
resistance
If change in CO or SVR is proportional and
reciprocal, the MAP will not change
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MAP (CO) x (SVR)
Normally arterial venous pressure maintained
within a narrow range, so changes in flow are
primarily a result of changes in vascular
resistance
( Difficult to measure SVR size, shape, number
vessels, blood-viscosity )
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?? 20 ?????? 2-3 ??????? 2550
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Pressure measurement or arterial pressure
waveform
Estimate stroke volume (SV)
Cardiac Output
CO (SV) x (Heart rate)
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?? 20 ?????? 2-3 ??????? 2550
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Pulse contour methods
Beat to beat basis pressure pulse waveform
The area under the curve from the initial rise
to the dicrotic notch reflects the amount of
blood ejected during systole and therefore
reflects stroke volume.
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?? 20 ?????? 2-3 ??????? 2550
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Pulse contour methods
Arterial pressure
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?? 20 ?????? 2-3 ??????? 2550
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Relationship of pressure measurements and flow
need
Algorithms using empiric formulas or prediction
models based on the patients height, weight, age
and gender
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?? 20 ?????? 2-3 ??????? 2550
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Arterial Circulation Models
2 element Windkessel
3 element Windkessel
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?? 20 ?????? 2-3 ??????? 2550
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Pressure Pulse Contour CO Today
Less invasive
PiCCO calibrated by transpulmonary thermodilution
PulseCO calibrated by transpulmonary lithium
dilution
FloTracTM CO no need for cal.
Non-invasive
Finapres CO
(finger arterial pressure CO)
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?? 20 ?????? 2-3 ??????? 2550
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PiCCO plus AO pres. femoral line
(PiCCO Pulse-induced contour cardiac output)
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?? 20 ?????? 2-3 ??????? 2550
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PulseCO / LiDCO
( not sensitive to temperature,influenced by
electrolyte hematocrit concentrations,
calibration every 4-6 or 8 Hr )
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?? 20 ?????? 2-3 ??????? 2550
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FloTracTM
( need no external calibration, pulse pressure
measured time windows 20 seconds )
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?? 20 ?????? 2-3 ??????? 2550
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CO Partial CO2 rebreathing
NICO system uses Ficks principle applied to
carbon dioxide for cardiac output
Based on changes in end-tidal carbon dioxide
after a brief of rebreathing
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?? 20 ?????? 2-3 ??????? 2550
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Partial CO2 rebreathing Equation
VCO2
_______________
CO
CvCO2 CaCO2
VCO2 production of CO2

CvCO2 mixed venous CO2 content
CaCO2 arterial CO2 content
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?? 20 ?????? 2-3 ??????? 2550
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NICO Ventilator
CO2 sensor
Disposable automatic rebreathing valve
CO2 / Flow sensor
NICO LoopTM
Disposable rebreathing loop intermittent
partial rebreathing state in cycles of 3 min.
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?? 20 ?????? 2-3 ??????? 2550
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Impedance Cardiography
Truly non-invasive CO
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?? 20 ?????? 2-3 ??????? 2550
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Blood Flow (DV)
(DR, DZ)
electrodes
Z meter
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?? 20 ?????? 2-3 ??????? 2550
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Demod
DZ
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?? 20 ?????? 2-3 ??????? 2550
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Thoracic Bioimpedance
Zb rb(L / DA)
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?? 20 ?????? 2-3 ??????? 2550
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ICG CO Monitoring current source 2- 4
mA,50-100KHz
Inner sensors Measure Z
Outer electrodes Transmit current
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?? 20 ?????? 2-3 ??????? 2550
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BioZ DZ, DZ / Dt, Fiducial points
DZ
DZ/Dt
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?? 20 ?????? 2-3 ??????? 2550
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Stroke Volume Thoracic bioimpedance
(cylinder model)
(trancated cone model)
r, electrical resistivity of blood L, distance
between two levels of electrodes d, correction
factor depending on weight LVET, left
ventricular ejection time H, height Z0, basic
thoracic impedance
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?? 20 ?????? 2-3 ??????? 2550
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ICG CO advanced signal processing time-frequency
analysis
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?? 20 ?????? 2-3 ??????? 2550
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ICG CO Monitor
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?? 20 ?????? 2-3 ??????? 2550
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CO Equipment Doppler shift frequency
1960s aortic blood flow using Doppler
percutaneous probe
1971 CW Doppler blood flow velocity waveform
1974 Esophageal Doppler and pulsed echo for
aortic volumetric measurement
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?? 20 ?????? 2-3 ??????? 2550
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Ultrasound-Echo-Doppler
(CW, continuous wave PD, pulsed Doppler PRF,
pulse repetition frequency)
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?? 20 ?????? 2-3 ??????? 2550
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Doppler equation
C fd
_________
V
2 fT cos q
v flow velocity c speed of sound
(in body
tissue1540m/s) fd frequency shift (Hz) cos
q cosine angle between sound beam axis
velocity vector fT frequency of transmitte
ultrasound (Hz)
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?? 20 ?????? 2-3 ??????? 2550
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Flow direction Transducer angle
Velocity profile curved tube (Aorta)
IV
V
I
II
III
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?? 20 ?????? 2-3 ??????? 2550
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Transesophageal Doppler Echocardiography
AO
Transducer
Aortic valve
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?? 20 ?????? 2-3 ??????? 2550
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Transesophageal Doppler 2D image
Time (ms)
Flow velocity (cm/s)
(VTI) x (AVA) SV
(SV) x (HR) CO
(VTI velocity time integral, AVA aortic valve
area)
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?? 20 ?????? 2-3 ??????? 2550
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Transesophageal Doppler 2D Image
AVA
VTI
(VTI) x (AVA) SV
(SV) x (HR) CO
(VTI velocity time integral, AVA aortic valve
area)
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?? 20 ?????? 2-3 ??????? 2550
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Esophageal Doppler (Only flow signal)
Esophageal
DP (Doppler probe)
(VTI velocity time integral, A aorta cross
section area)
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?? 20 ?????? 2-3 ??????? 2550
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Esophageal Doppler (Only flow signal)
ECG
Vao (cm/s)
Stroke distance
(VTI velocity time integral)
0
Time (sec)
VTI
SV VTI x A
Aortic diameter
CO SV x HR
Stroke volume
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?? 20 ?????? 2-3 ??????? 2550
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Aorta
Esophagus
Transesophageal pulse Doppler A-scan echo
(Two in one probe)
Pulse Doppler transducer for Flow velocity
Ultrasound transducer for diameter
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?? 20 ?????? 2-3 ??????? 2550
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Ultrasonic Cardiac Output Monitor
(Non invasive CO Transcutaneous CW Doppler Probe)
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?? 20 ?????? 2-3 ??????? 2550
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Conclusion CO Equipment, CCO Noninvasive ?
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?? 20 ?????? 2-3 ??????? 2550
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END NOW
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?? 20 ?????? 2-3 ??????? 2550