(精选)The Nexfin HD - Potential Applications教学课件.pptVIP

Passive leg raising-induced changes in CO can reliably predict fluid responsiveness regardless of ventilation mode and cardiac rhythm. Passive leg raising-induced changes in CO have a significantly higher predictive value than passive leg raising-induced changes in arterial pulse pressure. The hemodynamic response to a 15-second end-expiratory occlusion can predict volume responsiveness in mechanically ventilated patients. The accumulation of evidence showing that increasing DO2 in high-risk surgical patients may reduce morbidity and save lives has led Boyd and Bennett to claim that it may be considered unethical not to use goal-directed perioperative therapy once patient identification and the methods to be used in treating them are refined. Unlike approaches that adopt a specific clinical practice, like liberal or restrictive fluid regimen, goal-directed approaches employ various monitoring techniques and interventions in order to achieve specific end-points for selected parameters. Cardiac index (CI) Stroke volume (SV) Oxygen delivery (DO2) Mixed venous (SvO2) or central venous (ScvO2) oxygen saturation Lactate concentration pHi A bolus of 200 ml colloid (e.g., 6% HES 130/0.4) is administered over 2 min, and 5 min later the SV is assessed. The procedure is repeated if there was an increase in SV of 10%. When the fluid bolus does not result in a SV increment 10%, optimization is regarded as achieved and surgery commenced. Intermittent TD CO measurements have a well known intrinsic limited reproducibility which makes them inferior to continuously measured real-time CO in the process of perioperative optimization. Optimization – when and how? Transesophageal Doppler ultrasound Patient needs to be anesthetized The Vigileo system Patient needs to have an arterial line The Nexfin HD Totally non-invasive Optimization – when and how? NEXFIN CO (CI 4.5 L/min/m2) and oxygen transport goals (DO2I ≥600 ml/min/m2) are important so d