Right cardiogenic shock with low PAOP
, typically from RV infarction, not a frequent cause, is dealt with apart in the FALLS-protocol (the usual practice of an ECG in a shock by the way simplifies the approach).
Lee and colleagues compared methods of estimating cardiac preload, with the aim of evaluating the relationship between a dynamic hemodynamic parameter, PVI (derived from pulse oximetry), and RVEDVI (using a PAC), as well as comparing PVI to the static measures CVP and PAOP
. They measured the four hemodynamic parametersCVP, PAOP
, RVEDVI, and PVIon 18 patients undergoing OLT at 10 defined time points before, during, and at the conclusion of surgery.
Un metodo sencillo que combina los cambios dinamicos y estaticos es el levantamiento de piernas a 45 grados, este evalua cambios en la presion arterial media, incremento en gasto cardiaco y PAoP
, por el retomo producido por la fuerza de gravedad del levantamiento de piernas que equivale a un estimado de 500cc de solucion salina que se redirige a los vasos centrales, ofrece un valor predictivo de hipovolemia bueno (sensibilidad de 68% y especificidad de 89% con un area debajo de la curva de 0.95) lo anterior lo convierte en un metodo eficaz y factible en la toma de decisiones al reponer liquidos en un paciente criticamente enfermo, (10) esta medicion ha sido avalada recientemente por metaanalisis en el cual se incluyen pacientes intubados.
Baseline cardiorespiratory variables were measured 10 minutes before the propofol induction (T-10) and included: heart rate (HR; beats [minute.sup.-1]), systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP; mmHg), CVP (cm[H.sub.2]O), CO (L [minute.sup.-1]), mPAP (mmHg) and PAOP
(mmHg), respiratory rate ([f.sub.R]; breaths [minute.sup.-1]), body temperature (BT; [degrees]C) and arterial blood gas (partial pressure of oxygen--pa[O.sub.2] and carbon dioxide--paC[O.sub.2] (mmHg), pH, HC[O.sub.3.sup.-] (mEq [L.sup.-1]), base excess- BE (mEq [L.sup.-1]), and oxyhemoglobin saturation - Sa[O.sub.2] (%)).
Essentially, this was goal-directed therapy with supranormal haemodynamic targets that in order of priority, aimed for oxygen delivery of 550 to 600 ml/minute/[m.sup.2], a cardiac index of 3.5 to 4.5 l/minute/[m.sup.2], a mean arterial pressure greater than 70 mmHg, a PAOP
greater of 18 mmHg, a heart rate of less than 120 bpm and a haematocrit greater than 27%.
was obtained prior to the completion of an expiratory pause.
Patient data were recorded hourly and included heart rate, blood pressure, central venous pressure, PAOP
, cardiac index (CI), D[O.sub.2] Sv[O.sub.2] and vasopressor or inotrope use.
And equally importantly if intensivists did reach a consensus of opinion, could the operators at the coalface consistently and accurately read the real PAOP
in different patients' settings, e.g.
Mean arterial pressure (MAP, mmHg), central venous pressure (CVP, mmHg), mean pulmonary artery pressure (MPAP, mmHg) and PAOP
(mmHg) were recorded with quartz pressure transducers.
As a result, pressure-based surrogates, such as central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP
) have been measured clinically to assess volume status and response to fluid therapy (20).
In our report, during the first T-piece trial in all three patients, PAP and pulmonary artery occlusion pressure (PAOP
) were both elevated (Table 1).
A pulmonary artery catheter was then introduced to monitor pulmonary pressures: pulmonary artery pressure (PAP) was 49/26 mmHg, mean 34 mmHg; mean occlusion pressure--(PAOP
) was 13 mmHg and mixed venous saturation 73.7%.