HEMODYNAMIC

MONITORING
 OBJECTIVES
➢Discuss the importance of
hemodynamic monitoring
➢List and define the different
hemodynamic monitoring devices
➢Enumerate the uses and
complications of the different
hemodynamic monitoring devices
❑Arterial Pressure Monitoring
❑Central Venous Pressure (CVP)
Monitoring
❑Pulmonary Artery Pressure
(PAP) Monitoring / PAC
❑Cardiac Output (CO)
❑Pulse Oximetry
 ◦ plays an important role in the
assessment and treatment of critically
ill patients
◦ It is performed to evaluate:
◦ intravascular fluid volume by
measuring central venous pressure
HEMODYNAMIC (CVP)
MONITORING ◦ cardiac function by measuring
arterial blood pressure, pulmonary
artery wedge pressure (PAWP), and
cardiac output (CO)
◦ vascular function by measuring
systemic and pulmonary vascular
resistance.
 Invasive hemodynamic monitoring is
needed because basic clinical
assessments such as evaluating jugular
venous distention or heart sounds
alone may not accurately reflect
patients’ hemodynamic status.

Bedside monitors acquire and

Hemodynamic calculate physiologic data in real
time and often transfer the data
Monitoring automatically to computers for
trend analysis.

Monitors may not always provide accurate

information. Therefore, optimal invasive
monitoring requires not only knowledge
of the procedural complications and use
of the information but also understanding
and control of the factors affecting the
validity of the data.
 HEMODYNAMIC PRESSURE
RELATIONSHIP
◦ When discussing hemodynamic parameters, it is
necessary to think of the heart as two separate
pumps.
◦ The right heart receives blood from the venous
system (venous return) and pumps blood to the
pulmonary system.
◦ The left heart receives blood from the pulmonary
system and pumps blood to the systemic circulation.
◦ In normal states, both hearts pump at the same time
and move the same amount of blood.
 HEMODYNAMIC
PRESSURE
RELATIONSHIP
◦ Both atria are filling chambers for
the ventricles.
◦ Their pressures are about equal, and
they have the same waveform.
◦ When the atrioventricular valves
open (tricuspid and mitral), the
pressures in the atrium and ventricle
are equal; therefore, atrial pressure
usually reflects the ventricle’s filling
pressure (end-diastolic pressure).
 HEMODYNAMIC
PRESSURE RELATIONSHIP
◦ Both ventricles pump blood into arterial systems
and create two waveforms: ventricular and
arterial.
◦ Their waveforms have the same shape
characteristics, but their pressures are significantly
different.
◦ The right heart pumps to a low-resistance circuit,
the lungs, and thus produces a lower pressure.
◦ The left heart pumps to a high-pressure circuit,
the body, so it has to produce a high pressure.
 HEMODYNAMIC PRESSURE RELATIONSHIP
◦ Alterations in blood flow and resistance to flow
are reflected backward through the
cardiopulmonary circuit as pressure changes.

◦ Pulmonary hypertension causes pressure to

increase in the right heart and eventually the
venous system:

LUNG PRESSURE PAP CVP VENOUS CONGESTION

 HEMODYNAMIC PRESSURE RELATIONSHIP

◦ A failing left ventricle will cause blood to “dam up” in the

left heart, then the lungs, and eventually alters the entire
circuit:

LEFT ATRIAL PAWP PAP CVP VENOUS CONGESTION

PRESSURE
 HEMODYNAMIC PRESSURE
RELATIONSHIP
◦ The following simple diagram illustrates the dynamic relationship between the two
hearts and shows where pressures are measured.
◦ Marking a patient’s pressure changes helps clarify where there is and is not a problem
(e.g., increased PAWP with normal PAP and CVP indicates a left heart problem that has
not altered the lungs or right heart).
I. ARTERIAL PRESSURE
MONITORING
❖ Indications for Arterial Pressure Monitoring
◦ patient with significant hemodynamic instability
◦ patient who will require frequent arterial blood sampling
◦ Patients with:
◦ severe hypotension (shock)
◦ severe hypertension
◦ unstable respiratory failure (acute respiratory distress syndrome [ARDS]) are
likely candidates to have continuous arterial pressure monitoring.
◦ Patients in need of medications that affect BP (e.g., vasodilators or
inotropic agents) may benefit from arterial pressure monitoring.
❖ Arterial Catheter
Insertion Sites
◦ Arterial catheters may be
placed in the radial, ulnar,
brachial, axillary, or femoral
arteries.
❖RADIAL Site
◦ is preferred because it is readily
accessible and usually has
adequate collateral circulation
through the ulnar artery
◦ - is easy to monitor and provides a
stable location for blood sampling.
❖ Arterial Catheter Insertion
Sites
◦ Arterial catheters may be placed in the
radial, ulnar, brachial, axillary, or femoral
arteries.
❖FEMORAL artery
◦ provides pressure measurements that are less
affected by peripheral vasoconstriction, but
significant leakage of blood into the
surrounding tissue can occur without detection
◦ -is more prone to contamination than the other
locations.
 ❖ Equipment Set-up
◦ Once inserted, the catheter connects to a
disposable continuous flush device by low-
compliance tubing.
◦ The flush device keeps the line open by
providing a continuous low flow of fluid (2
to 4 mL/hour) through the system.
◦ To maintain continuous flow, the
intravenous bag supplying these systems
must be pressurized, usually by a hand
bulb pump.
 ❖ Equipment Set-up

◦ A pressure transducer, connected to the

flush device, provides an electrical signal
to an amplifier or monitor, which displays
the corresponding pressure waveform.
◦ A sampling port typically is included to
allow blood withdrawal.
◦ CVP and pulmonary artery monitoring
systems use the same basic set-up.
❖ Arterial Line Insertion
◦ Perform Allen’s Test
◦ There are two common arterial
line insertion methods:
1. Direct cannulation
◦ uses a puncture needle sheathed
with the catheter
◦ Using this approach, once a flash of
blood is observed in the needle
hub, the catheter sheath is
advanced over the needle into the
artery, and the needle is then
removed.
❖ Arterial Line Insertion
2. Guidewire (Seldinger) technique
◦ a needle is used to penetrate the
artery, with a soft-tipped
guidewire then threaded through
the needle into the vessel.
◦ Next, the needle is removed,
leaving the guidewire in place.
◦ Finally, the indwelling catheter is
advanced over the guidewire into
position, and the guidewire is
removed.
 Arterial Pressure Waveform
An arterial pressure waveform
should have a clear upstroke on the
left, with a dicrotic notch
representing aortic valve closure on
the downstroke to the right.

If the dicrotic notch is not visible, the

pressure tracing is dampened and
probably inaccurate, and the
measured pressures likely lower than
the patient’s actual values.

The dicrotic notch disappears in

some patients when the systolic
pressure drops below 50 or 60
mm Hg.
❖ Interpretation of Arterial
Pressure Measurements
◦ Normal arterial pressure in the adult is
approximately 120/80 mm Hg and increases
gradually with age.
◦ Systolic pressures >140 and diastolic
pressures >90 are considered hypertensive
◦ A pressure <90/60 mm Hg in adults is termed
hypotension.
◦ Pressure is the product of flow and resistance.
❖ Interpretation of Arterial
Pressure Measurements
◦ Because neurovascular compensatory
mechanisms can maintain blood pressure by
vasoconstriction while flow is decreasing, low
BP is a late sign of hypovolemia or impaired
cardiac function.
◦ Earlier evidence of decreased blood volume
or CO includes cold, clammy extremities
caused by catecholamine-mediated
peripheral vasoconstriction.
 ➢With hypovolemia from fluid or
Arterial blood loss (most commonly,
pressure bleeding)
decreases in
the following ➢During cardiac failure and
circumstances: shock (most commonly, heart
attack)
 ➢With vasodilation (most commonly,
sepsis or anesthetic agents)
◦ Diastolic pressure must be
watched carefully during the
Arterial administration of vasodilators
pressure such as sodium nitroprusside,
decreases in which may reduce diastolic
the following pressure more rapidly than
systolic or mean pressure.
circumstances: ◦ Diastolic pressure <50 mm Hg
and mean pressure <60 mm Hg in
an adult may result in
compromised coronary perfusion.
 ➢Improvement in circulatory
volume and function
➢Sympathetic stimulation
Arterial (e.g., fear or medications)
pressure ➢Vasoconstriction
➢Administration of
increases vasopressors
with the ◦ If a + inotropic drug
stimulates the heart under
following: conditions of inadequate
myocardial oxygenation or
hypovolemia, the pressure
may fall.
 ➢Administration of
vasopressors
Arterial ◦ If the inotropic agent also
causes vasodilation, the
pressure pressure may stay the same or
increases fall as the medication is
increased.
with the ◦ In addition to systolic and DBP,
following: arterial pressure monitoring
allows assessment of pulse and
mean arterial pressure.
 ◦ is the difference between the systolic
and diastolic pressure.
Pulse ◦ Normal pulse pressure is 30-40 mm

Pressure Hg
◦ is a reflection of left ventricular stroke
volume (SV) and arterial system
compliance
 ◦A pulse pressure of <30 mm Hg
indicates low left ventricular SV.
Pulse
Pressure ◦An increasing SV in a patient
receiving fluid therapy is
consistent with improved
preload.
 Mean Arterial Pressure
(MAP)
◦ is an average of pressures in the systemic
circulation and thus the pressure best associated
with the adequacy of tissue perfusion.
◦ The normal reference range for MAP is 70 to
105 mm Hg.
◦ MAP is not an arithmetic average of systolic and
diastolic pressures because the cardiac cycle
spends about twice as long in diastole as in
systole when the heart rate is normal.
Mean Arterial Pressure (MAP)

◦ Most monitors compute MAP and display it digitally.

◦ MAP can be estimated mathematically by either of the
following formulas:
 ❖ Complications Associated with
Arterial Lines

ISCHEMIA HEMORRHAGE INFECTION

 ISCHEMIA
◦ Ischemia resulting from embolism,
thrombus, or arterial spasm is the
major complication of direct
arterial monitoring.
◦ It is evidenced by pallor distal to
the insertion site and usually is
accompanied by pain and
paresthesia (numbness and
tingling).
◦ Ischemia can proceed to tissue
necrosis if the catheter is not
repositioned or removed.
 ISCHEMIA
◦ Thrombosis is prevented
by irrigation with diluted
heparinized solution.
◦ Bolus irrigation is done in
very small amounts
because flushing the line
can result in retrograde
flow and cerebral
embolization.
 HEMORRHAGE
◦ Hemorrhage is possible if the line
becomes disconnected or a stopcock is
left open; therefore, the tubing should be
kept on top of the bed sheets, where it
can be observed.
◦ Blood flow through an 18-gauge catheter
is sufficient to allow a 500-mL blood loss
per minute, and exsanguination can occur.
 HEMORRHAGE
◦Bleeding and hematoma at the
insertion site can also occur,
especially if the catheter was placed
through a needle.
◦Sites should be assessed regularly
while the catheter is in place and
after its removal.
 INFECTION
◦ As with all invasive lines, the presence of an
arterial catheter increases the risk for infection.
◦ The incidence of infection increases over time
and is directly related to the care of the lines
and transducers; frequency of dressing, tubing,
and solution change; to-and-fro motion of the
catheter; and altered host defenses.
◦ Fever in any patient with invasive lines must
trigger questions about the necessity of the
lines and their role as a cause of the infection
process.
II. CENTRAL VENOUS
PRESSURE
 CENTRAL VENOUS PRESSURE (CVP)

◦ Central venous pressure (CVP) is the pressure of the blood in the RA or vena
cava, where the blood is returned to the heart from the venous system.
◦ Because the TV is opened between the right atrium and ventricle during
diastole (ventricular filling), CVP also represents the end-diastolic pressure in
the right ventricle (RVEDP) and reflects right ventricular preload (filling
volume).
◦ To obtain a CVP measurement, a venous catheter is placed in a major vein
◦ Normal CVP: 2-6mmHg
 oCVP monitoring is indicated to assess
the circulating blood volume (adequacy
of cardiac filling), adequacy of venous
return, or right ventricular function.
➢Patients who have had major surgery
❖ INDICATIONS or blood loss caused by trauma
➢those suspected of severe
for CVP dehydration may benefit from
Monitoring placement of a CVP catheter to guide
fluid replacement therapy.
➢Patients with either cardiogenic or
noncardiogenic pulmonary edema
also need CVP monitoring to guide
fluid therapy.
 ouseful in evaluating patients
suspected of having right
ventricular damage due to MI
oOnce the catheter is in place,
❖ INDICATIONS the line can be used for rapid
for CVP infusion of fluids or
Monitoring medications and to obtain
blood samples for
measurement of routine
laboratory studies (e.g., CBC
& electrolytes).
 ❖CVP Catheters
◦ 7-French, triple-lumen catheters with one distal port and two
ports 3 to 4 cm from the distal end of the catheter
◦ The multiple-lumen catheter allows infusion of blood and
various medications and solutions through different ports and
permits aspiration of blood samples or injections for CO
measurements without interrupting the infusion of
medication.
◦ Catheters with walls that are impregnated with antibiotics are
less commonly associated with infection than standard
catheters.
❖ CVP Insertion Sites
◦ Common sites:
❑SUBCLAVIAN VEIN
➢ADVANTAGE: it results in a much more
stable catheter after placement.
➢DISADVANTAGE: it is technically more
difficult because the vein is harder to find
and the catheter guidewire does not
follow the subclavian vein as easily as it
turns to form the superior vena cava.
➢subclavian vein is close to the
subclavian artery, which is easily
punctured, and the mediastinum can
hold a fair amount of blood without
external evidence of blood loss.
CVP Insertion
Sites

➢The The pleural

surface is not far below
the vein, so
pneumothorax is a
potential complication
of the procedure.
 ❖CVP Insertion Sites
◦Common sites:
❑INTERNAL JUGULAR VEIN
➢ADVANTAGE: is easier because
there is nearly a straight shot for the
guidewire to reach the superior
vena cava and less risk for
pneumothorax, and hematomas are
easier to see and control
 ❖CVP Insertion Sites
◦Common sites:
❑INTERNAL JUGULAR VEIN
➢DISADVANTAGE: the catheter is
much less stable after placement
and is subject to kinking,
breakage, and accidental
✓A chest radiograph should be
removal.
performed after central venous line
insertion to ensure proper placement
and to rule out pneumothorax.
 ◦ The technique is nearly identical for
subclavian and internal jugular line
insertions.
◦ The head of the patient’s bed is
❖INSERTING lowered:
a CVP ➢which increases venous pressure and
Catheter causes the vein to swell, making it
easier to penetrate and thread the
guidewire
➢decreases the risk for inadvertent air
embolism
 ❖INSERTING a CVP Catheter
◦ The subclavian vein is entered from an insertion site at the
edge of the distal third of the clavicle.
◦ The internal jugular vein can be entered from the head of
the clavicle or a site behind the brachial artery.
◦ It is advanced to a depth that should leave the tip in the
superior vena cava.
◦ The chest radiograph typically is taken after insertion to
verify the tip of the catheter is in the SVC just above the
right atrium.
❖INSERTING a CVP Catheter
◦ CVP catheter is attached to a
flushed and calibrated monitoring
system like that used for pressure
measurement through an arterial
line
◦ However, because central venous
pressures typically are much lower
than arterial pressures, two key
differences in the procedure are
required:
❖INSERTING a CVP Catheter
◦ two key differences in the procedure
are required:
✓The monitor scale for CVP
measurement should be set to the
low range, 0-30 mm Hg
✓To assure accuracy in measurement
and interpretation, the pressure
transducer must be placed level with
the patient’s right atrium, identified
externally at the phlebostatic axis.
 ❖INSERTING a CVP Catheter

◦ Positioning of the transducer below the phlebostatic axis will result in

erroneously high CVP readings
◦ Positioning the transducer above this level will cause the reading to be lower
than the patient’s actual value.
 ◦ CVP is regulated by a balance
between the volume of blood
being returned to the heart
(venous return) and the ability of
❖ INTERPRETATION the right heart to pump this
of
CVP
blood out into the pulmonary
measurements circulation.
◦ Any peripheral factor that
decreases the amount of blood
returning to the heart decreases
CVP
❖ INTERPRETATION of CVP
measurements
◦ Any factor that increases venous return
increases CVP
◦ When the pumping capacity of the right
heart is increased, more blood is moved
out of the right ventricle, and CVP
decreases.
◦ Conversely, any impairment to the
pumping ability of the right heart tends
to increase CVP.
 ✓Volume overload or fluids
being given more rapidly
than the heart can tolerate
✓Increased intrathoracic
pressure (CVP increases with
❑ INCREASE
positive-pressure breath or
CVP tension pneumothorax)
✓Compression around the
heart: constrictive
pericarditis or cardiac
tamponade
 ✓Pulmonary hypertension
(primary or secondary)
✓Right ventricular failure (e.g., MI
❑ INCREASE
or cardiomyopathy)
CVP
✓Left heart failure severe enough
to cause right heart failure
✓Pulmonary valvular stenosis
 ✓Tricuspid valvular stenosis
or regurgitation
✓Pulmonary embolism
❑ INCREASE
CVP ✓Increased large vessel
tone throughout the body,
resulting in
venoconstriction
 ❑ INCREASE CVP
✓Arteriolar vasodilation that increases the
blood supply to the venous system
✓Infusion of solution into the CVP line
(especially by infusion pumps)
✓Placement of the transducer below the
patient’s right atrium and phlebostatic
axis
 ✓Vasodilation (drugs hyperpyrexia,
sepsis)
✓Inadequate circulating blood
volume (hypovolemia) caused
❑ DECREASE ✓by dehydration, blood loss, GI loss,
CVP wound drainage, perspiration, UO
(diuresis), insensible losses (high
temperature, low humidity), and
losses to the interstitial space
(edema, third spacing)
 ❑ DECREASE CVP

✓Spontaneous inspiration
✓Placement of the transducer
above the patient’s right atrium
and phlebostatic axis
✓Air bubbles or leaks in the
pressure line
 CVP Monitoring
◦ CVP monitoring is best used for patients without preexisting
cardiac disease as one indicator of the adequacy of venous
return and cardiac filling.
◦ An intravenous fluid challenge is employed to aid in
determining whether decreased BP is due to hypovolemia or to
cardiogenic failure.
◦ Measurements of CVP are affected by ventilation because
transthoracic pressure is transmitted through the pericardium
and the thin-walled venae cavae.
 CVP Monitoring
◦ During spontaneous ventilation,
inspiration lowers CVP, and
exhalation increases it.
◦ The situation is reversed in
patients being mechanically
ventilated, in whom inspiration
increases intrathoracic pressure
and elevates CVP.
 ❖ COMPLICATIONS
of CVP Monitoring
◦ Placement of the catheter can
cause problems such as:
❑Bleeding
➢is often minimal because of the
low pressures characterizing the
venous system
➢is more likely if the patient is
taking heparin or has low platelet
counts
➢can be severe if the subclavian
artery is accidentally penetrated
❖ COMPLICATIONS
of CVP Monitoring
◦Placement of the catheter
can cause problems such
as:
❑Pneumothorax
➢is uncommon but can
occur if the catheter
punctures the pleural
lining
 ❖ COMPLICATIONS
of CVP Monitoring
◦ The most common complication
with use of the catheter over
time is infection
◦ A less common complication is
development of thrombus
around the catheter.
◦ Accidental opening of the
central venous line stopcock
could allow air to enter the vein
and result in an air embolus.
III. PULMONARY ARTERY
PRESSURE (PAP)
 PAP Monitoring
◦ The development of the PAC by Drs. Swan and Ganz in the late 1960s
began a new era in assessment of left ventricular function and
hemodynamic performance.
◦ Placement of a flow-directed PAC into the patient’s pulmonary artery
allows assessment of the filling pressures of the left side of the heart.
◦ PAC provides better assessment of left-sided heart function
◦ PAC provides the means to assess CO and tissue oxygenation.
 ◦Unfortunately, there is no
specific diagnosis or
group of patients in
❖ INDICATIONS which PAC placement is
for PAP an absolute indication.
Monitoring ◦Rather, the decision to
place a PAC is
individualized on a case-
by-case basis.
❖ INDICATIONS for PAP
Monitoring
◦ The common situations in which PAC
monitoring is considered include the
following:
➢Diagnosis and treatment of patients with
severe cardiogenic pulmonary edema,
especially if the patient has unstable angina,
has ventricular pathology, or does not respond
to initial therapy
➢Diagnosis and treatment of patients with
severe ARDS who are hemodynamically
unstable
 ❖ INDICATIONS for PAP
Monitoring
◦ The common situations in which PAC
monitoring is considered include the
following:
➢Monitoring of patients who have had major
thoracic surgery (e.g., coronary bypass
surgery) with a recent history of myocardial
infarction or poor ventricular function
➢Diagnosis and treatment of patients in
cardiogenic or septic shock
❖ PAC & Insertion Sites

◦ PACs, also called Swan-Ganz catheters

◦ are made of radiopaque
polyvinylchloride
◦ the adult version 110 cm long (marked
in 10-cm increments) and tipped with a
small inflatable balloon
◦ A 5-French catheter typically is used
with children up to 20 kg.
❖ PAC &
INSERTION
SITES
 ◦PAP decrease when the
volume of blood ejected by
the right ventricle decreases
or when the pulmonary
❖ Interpretation vasculature relaxes or dilates
of PAP (decreased PVR).
◦PAP increase when pulmonary
blood flow increases or when
PVR increases.
 ◦ Examples of conditions that can
cause increased PVR include the
following:
➢Pulmonary emboli
➢Acute or chronic lung disease that
causes pulmonary vasoconstriction
❖ Interpretation in response to hypoxia
of PAP ➢Cardiac tamponade or increased
intrathoracic pressure compressing
the vasculature and impeding
forward flow
➢ Left HF and mitral valve
regurgitation causing backpressure
from the left heart into the lungs
 ◦Pulmonary artery pressure
❖ Interpretation increases with the following:
of PAP: ✓Increased venous return
(volume)
INCREASE
✓Increased intrathoracic
PAP
pressure
✓Increased PVR
 ◦ If pressure is abnormally high or
climbing, think of the following:
✓Increased PVR
✓Constriction, obstruction,
❖ Interpretation compression of pulmonary
vasculature (e.g., ↑ intrathoracic
of PAP: pressure, pulmonary
hypertension, or cardiac
INCREASE tamponade)
✓Backpressure from high left
PAP heart pressures
✓Volume overload
✓Technical problem or not
reading at end-expiration
 ◦Pulmonary artery pressure
❖ Interpretation decreases with the following:
of PAP: ✓Decreased venous return
(volume)
DECREASE ✓Decreased intrathoracic
PAP pressure
✓Decreased PVR
 ◦If pressure is abnormally
low or falling, think of the
❖ Interpretation following:
of PAP: ✓Inadequate volume,
volume loss
DECREASE ✓Vasodilation (could be
PAP fever or medications)
✓Plumbing or
measurement problem
◦ During cannulation of a central
vein: pneumothorax,
hydrothorax, hemothorax, air
embolism, and damage to the
vein, nearby arteries, or nerves ❖ COMPLICATIONS
to occur. of
PAP
◦ Movement of the catheter
inside the heart can trigger:
BBB and supraventricular or
ventricular dysrhythmia.
 ◦Perforation of the heart
or pulmonary artery is
possible.
❖ COMPLICATIONS
of ◦The PAC is a source of:
PAP embolus, thrombus,
bleeding, hematoma,
site infection, and
sepsis.
◦ Pulmonary infarction and even
PA rupture can result from
overfilling the balloon while
obtaining a wedge pressure, as
well as from catheter migration.
◦ Pulmonary infarction should be
❖ COMPLICATIONS
suspected and assessed of PAP
whenever a patient with a PAC
coughs up blood-tinged
sputum.
◦ An overfilled balloon can
rupture, causing possible
fragment or air embolism.
 ◦ Lidocaine and emergency
resuscitation equipment
should be immediately
available at both insertion and
❖ COMPLICATIONS removal.
of PAP ◦ Catheter resistance during
removal is not normal and is
an indication for obtaining a
chest radiograph to assess the
cause.
IV. CARDIAC
OUTPUT
(CO)
 CARDIAC OUTPUT Monitoring

◦ provides essential information regarding the adequacy of perfusion

and helps guide the management of patients at increased risk for
developing cardiac complications.
◦ Adequacy of perfusion is the most important factor in the assessment
of the cardiovascular system’s ability to meet the body’s metabolic
demands.
◦ Early detection of key circulatory function derangements allows the
clinician to begin proactive therapeutic interventions.
 ◦The amount of blood pumped out
of the left ventricle in a minute is
known as cardiac output (CO).
◦It is the product of heart rate (HR)
CARDIAC and stroke volume (SV), which is
OUTPUT the volume of blood ejected by
the ventricle by a single heartbeat
◦Normal SV for adults is 60 to 130
mL/beat and is roughly equal for
both the left and right ventricles.
 ◦ The average CO for men and
women of all ages is
approximately 5 L/minute at
rest (reference range is 4 to 8
CARDIAC L/minute)
◦ however, the normal CO for
OUTPUT an individual varies with age,
sex (10% higher in men), body
size, blood viscosity
(hematocrit), and the tissue
demand for oxygen.
Oxygen Consumption
 FRANK-
STARLING
MECHANISM
 V. PULSE
OXIMETRY
 Pulse oximetry affords a
noninvasive estimate of arterial
oxygen saturation using the
change in light absorption
across a vascular bed during

PULSE the arterial pulse.

OXIMETRY In the ICU, pulse oximetry

has important uses and
has become a standard
of care in many
institutions.
PULSE OXIMETRY
is a noninvasive technique for measuring O2 saturation of
hemoglobin (Hb) in the blood, with the reported measure
being abbreviated as Spo2.

When compared with analysis of arterial blood Hb

saturation by invasive sampling and hemoximetry (Sao2)
among patients with good perfusion, pulse oximeters
exhibit an overall accuracy in the 2% to 4% range.
 PULSE OXIMETRY
◦ As the “fifth vital sign” : pulse oximetry
commonly is used in ICU, ER, OR, during
patient transport, and during special
procedures such as bronchoscopy, CT scan,
sleep studies, exercise testing, and weaning
from supplemental O2 and MV.
◦ Pulse oximetry also provides the basis for
prescribing and adjusting O2 therapy in
both the hospital and home care settings.
DO YOU HAVE ANY
QUESTIONS?
THANK YOU!