Prime the Pump, Make Some Waves: Facilitating Best Practice Hemodynamic Monitoring in Critical Care

Many patients admitted to adult Critical Care are in some degree of shock. The purpose of this session is to identify physiological concepts essential to hemodynamic monitoring, review widely used hemodynamic monitoring techniques, apply knowledge of hemodynamic principles to unstable, critically ill patients, and most importantly, thru case studies, evaluate the clinical response in these complex patients. [150 minutes]

Key Content

  • Shock in Critical Care - Types: Hypovolemic, Cardiogenic, Obstructive, Distributive, Pathophysiology of Shock
  • Blood Pressure, How BP is Regulated
  • Hypotension: Types of Hypotension, When Hypotension Occurs in ICU, What’s the Cause?, Compensatory Mechanisms in Shock
  • “VIP” Rule: Ventilate, Infuse, Pump
  • Hemodynamic Variables: Cardiac Output, Stroke Volume, Preload, Afterload, Contractility, Frank-Starling Mechanism
  • Approach to the Hemodynamically Unstable Patient in Shock - Monitoring Variables: Blood Pressure, Mean Arterial Pressure, Role of Central Venous Pressure (CVP) Monitoring, Lactate
  • Assessing Fluid Responsiveness: Types of Responders, IV Fluid Challenge
  • Primary Vasopressors and Inotropes: Norepinephrine and Vasopressin
  • Refractory Shock: Pathophysiology, Microcirculation vs. Macrocirculation
  • Beyond the Basics - Oxyhemoglobin Dissociation Curve: Central Venous vs. Mixed Venous Oxygen Saturation
  • Pulmonary Artery Catheter: Values, Waveforms, and Measurements, Pulmonary Capillary Wedge Pressure, Cardiac Index, Cardiac Output: Transpulmonary Thermodilution 
  • Vasopressors and Inotropes: Epinephrine, Dopamine, Dobutamine, Milrinone
  • Newer Strategies for Refractory Shock: Vitamin C, Thiamine and Steroids, Angiotensin II (Giapreza)
  • Rescue Therapies: Extracorporeal Membrane Oxygenation (ECMO), Methylene Blue
  • Future Directions