Week 6: Cardiovascular manipulation

Topics to Consider

• The basics of cardiovascular physiology

  • What's the difference between cardiac output and blood pressure?

  • How does this relate to the cardiac cycle?

• Causes of cardiovascular failure commonly encountered in a critical care

• What sorts of cardiovascular monitoring do we use in critical care

  • Arterial lines and CVP

  • Cardiac output monitors

  • Role of echocardiography

• Blood pressure targets - how and why?

• How can we manipulate the cardiovascular system

  • Fluids

  • Inotropes and vasopressors

  • Antidysrhythmics (there's more than just amiodarone)

  • Mechanical support

Resources

• Cardiac Failure (E-learning for health care)
• Cardiac Muscle physiology : (BJA Education)
• Use of inotropes and vasopressor agents in critically ill patients: (British Journal of Pharmacology)
• Blood pressure measurement : (BJA Education)
• Critical assessment of haemodynamic data : (BJA Education)
• Diastolic Dysfunction : (BJA Education)
• Diastolic Dysfunction in Anaesthesia and Critical Care : (BJA Education)
• Right Ventricular failure : (BJA Education)
• Ventricular Assist Devices : (BJA Education)
• Principles of intra-aortic balloon pump counterpulsation : (BJA Education)
• Cardiac Output : (frca.co.uk)

Cardiovascular monitoring

• Minimally invasive cardiac output monitoring : (BJA Education)
• Cardiac Output monitoring : (ATOTW)
• Haemodynamic monitoring in the critically ill: an overview of current cardiac output monitoring methods

Key trials and guidelines

• 65 - One MAP target to rule them all?
• VANISH and VASST (adding vasopressin to noradrenaline)

  • What about adding methylene blue? Or terlipressin?
• MIDAS (midodrine to liberate from vasopressors)
• SHoC-ED - does POC ultrasound add anything to the assessment of hypotension?

Have we missed something?

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