The Determination of Spinal Fluid Protein: An Attempt at ...
QUICK SETUP THE DETERMINATION FLUID STATUS...
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DETERMINATION OF FLUID STATUS * Fluid Bolus and Hemodynamic Response 45° Baseline: Semi-Recumbent position Obtain 3 min of monitoring for average baseline SVI If the last three SVI readings are stable, the PLR Test can be operated from the Challenge stage 30°-45° Challenge: Leg Raise Obtain 3 min of monitoring for SVI peak value Use a wedge cushion for ease of use and standardization Frank-Starling curve 17.1% PLR Fluid Responsive Not Fluid Responsive Menu >> Protocol >> PLR Test Interpretation: Fluid Responsive ΔSVI ≥ 10% Fluid Responsive: SVI & organ perfusion will likely increase in response to IV fluids 3-4 A positive test suggests that the patient is on the ascending limb of the Frank-Starling curve Interpretation: Not Fluid Responsive ΔSVI < 10% Not Fluid Responsive: SVI will remain flat or hardly increase in response to IV fluids A negative test suggests that the patient is on the flat limb of the Frank-Starling curve Access the PLR Wizard Conduct a reversible fluid challenge in order to determine fluid responsiveness The PLR wizard will display the peak hemodynamic change from the baseline over a 3min time span SVI Δ = 2.0% Example of a negative PLR Test indicating no fluid responsiveness Place & Connect Sensors Place sensors on patient’s body and attach connectors according to their color The CHEETAH Sensors should be positioned around the heart. The exact location is flexible. See sensor package for more information Main Menu Screen Select ‘New Patient’ Prewired Sensors Enter Patient Details Input: ID, Age, Height, Weight and Gender. Select Finish Review Data & Start Test Confirm data accuracy, select ‘Run’ then press ‘OK’ to begin test If inserted data is incorrect: select ‘Update Details’and re-enter data QUICK SETUP OF THE CHEETAH MEDICAL SYSTEM In five easy steps Turn On The Cheetah Medical Monitor Press the power button until the system turns on DETERMINATION OF FLUID STATUS * Passive Leg Raise (PLR) Patient Information Interpretation: Fluid Responsive ΔSVI ≥ 10% A positive test suggests that the patient is on the ascending limb of the Frank-Starling curve 1-2 Example of a positive Bolus Test indicating fluid responsiveness SVI Δ = 17.1% Menu >> Protocol >> Bolus Test Access the Bolus Test Wizard Conduct a fluid challenge in order to determine fluid responsiveness The Bolus Wizard will report on the peak hemodynamic change within the chosen time-frame. Useful also to capture hemodynamic impact of drug selection/titration Start the Bolus/ Drug Infusion •Activate the Bolus Test function of the CHEETAH monitor. •Administer a 3ml/kg IV Bolus over 5min 1 For optimal results ensure stable hemodynamics for 2min prior to the bolus ΔSVI < 10% Interpretation: Not Fluid Responsive A negative test suggests that the patient is on the flat limb of the Frank-Starling curve Example of a negative Bolus Test indicating no fluid responsiveness SVI Δ = 2.0% Bolus Test Results •At the end of the bolus challenge, stop the Bolus Test •Note the peak change in the Wizard Report 1 Cecconi M, Parsons AK, Rhodes A. What is a fluid challenge? Curr Opin Crit Care. 2011;17(3):290-5 2 Marik P, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Annals of Intensive Care 2011 3 Monnet X, Teboul JL. Passive leg raising. Intensive Care Med 2008; 34:659-63 4 Benomar B, Ouattara A, Estagnasie P, et al. Fluid responsiveness predicted by noninvasive Bioreactance-based passive leg raise test. Intensive Care Med. 2010;36(11):1875-81 CHEETAH Sensors should be replaced with a new set of sensors after 48 hours of use. Remember to preform a re-calibration after sensor replacement and once daily. CHEETAH NICOM STARLING SV
Transcript of QUICK SETUP THE DETERMINATION FLUID STATUS...
DETERMINATION OF FLUID STATUS*
Fluid Bolus and Hemodynamic Response
45°
Baseline:Semi-Recumbent positionObtain 3min of monitoringfor average baseline SVIIf the last three SVI readings arestable, the PLR Test can be operated from the Challenge stage
30°-45°
Challenge: Leg Raise
Obtain 3min of monitoringfor SVI peak value
Use a wedge cushion for ease of use and standardization
Frank-Starling curve
17.1%PLR
FluidResponsive
Not FluidResponsive
Menu >> Protocol >> PLR Test
Interpretation: Fluid Responsive ∆SVI ≥ 10%
Fluid Responsive: SVI & organ perfusion will likely increase in response to IV fluids3-4
A positive test suggests that the patient is on the ascending limb of the Frank-Starling curve
Interpretation: Not Fluid Responsive ∆SVI < 10%
Not Fluid Responsive: SVI will remain flat or hardly increase in response to IV fluidsA negative test suggests that the patient is on the flat limb of the Frank-Starling curve
Access the PLR Wizard
Conduct a reversible fluidchallenge in order to determine fluid responsivenessThe PLR wizard will display the peak hemodynamic change from the baseline over a 3min time span
SVI ∆ = 2.0%
Example of a negative PLR Test indicating no fluid responsiveness
Place & Connect SensorsPlace sensors on patient’s body and attach connectors according to their color
The CHEETAH Sensors should be positioned around the heart. The exact location is flexible. See sensor package for more information
Main Menu Screen
Select ‘New Patient’
Prewired Sensors
Enter Patient Details
Input: ID, Age, Height, Weight and Gender. Select Finish
Review Data & Start Test
Confirm data accuracy, select ‘Run’ then press ‘OK’ to begin testIf inserted data is incorrect: select ‘Update Details’and re-enter data
QUICK SETUP OF THE CHEETAH MEDICAL SYSTEM
In five easy steps
Turn On The Cheetah Medical Monitor
Press the power button until the system turns on
DETERMINATION OF FLUID STATUS*
Passive Leg Raise (PLR)
Patient Information
Interpretation: Fluid Responsive ∆SVI ≥ 10%
A positive test suggeststhat the patient is on theascending limb of theFrank-Starling curve1-2
Example of a positive Bolus Test indicatingfluid responsiveness
SVI ∆ = 17.1%
Menu >> Protocol >> Bolus Test
Access the Bolus Test Wizard
Conduct a fluid challenge in order to determine fluid responsiveness
The Bolus Wizard will report on the peak hemodynamic change within the chosen time-frame. Useful also to capture hemodynamic impact of drug selection/titration
Start the Bolus/ Drug Infusion
•Activate the Bolus Test function of the CHEETAH monitor.•Administer a 3ml/kg IV Bolus over 5min1
For optimal results ensure stable hemodynamics for 2min prior tothe bolus
∆SVI < 10%Interpretation: Not Fluid Responsive
A negative test suggests that the patient is on the flat limb of the Frank-Starling curve
Example of a negative Bolus Test indicatingno fluid responsiveness
SVI ∆ = 2.0%
Bolus Test Results
•At the end of the bolus challenge, stop the Bolus Test•Note the peak change in the Wizard Report
1 Cecconi M, Parsons AK, Rhodes A. What is a fluid challenge? Curr Opin Crit Care. 2011;17(3):290-52 Marik P, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Annals of Intensive Care 2011 3 Monnet X, Teboul JL. Passive leg raising. Intensive Care Med 2008; 34:659-634 Benomar B, Ouattara A, Estagnasie P, et al. Fluid responsiveness predicted by noninvasive Bioreactance-based passive leg raise test. Intensive Care Med. 2010;36(11):1875-81
CHEETAH Sensors should be replaced with a new set of sensors after 48 hours of use. Remember to preform a re-calibration after sensor replacement and once daily.
CHEETAH NICOM STARLING SV
680
equatio
nnorm
al range
Cardiac O
utput (CO
)
Cardiac Index (C
I)
Stroke Volum
e (SV)
Stroke Volum
e Index (SVI)
∆ Stroke V
olume Index (∆
SVI)
Mean A
rterial Pressure (MA
P)
Total Peripheral Resistance (TPR
)
Total Peripheral Resistance Index (TPR
I)
HR x SV
/1000
CO
/BSA
CO
/HR x 1000
SV/B
SA
∆ SV
I of 250ml over 3 to 5 m
inutes
Directly from
the oscillometric profile
80 x (MA
P)/CO
80 x MA
P/CI
parameter
4.0-8.0 l/min
2.5-4.0 l/min/m
2
60-100 ml/beat
33-47 ml/m
2/beat
<10% U
nlikely to be fluid responsive> 10%
Likely to be fluid responsive
70-105 mm
Hg
800-1200 dynes . sec/cm5
1970-2390
dynes . sec/cm5/m
2
patient 1 cardiogenic shock
patient 3 hypovolemic shock
patient 2 septic shock
normalvalues
normalvalues
normalvalues
parameter
110/70110/70
70/40110/70
70/40110/70
70/40bp
90150
90150
90150
hr
3.0 l/min/m
21.3 l/m
in/m2
3.0 l/min/m
25.9 l/m
in/m2
3.0 l/min/m
21.6 l/m
in/m2
ci
22703080
22702270
2500tpri
Diuretics, N
itrates, Cardiac inotropesIV Fluids, Antibiotics, Pressors
IV Fluidstreatm
ent
*response to plr
*An alternative method to check for fluid responsiveness is a norm
al saline fluid bolus.
NORMAL HEMODYNAMIC PARAMETERSAdult Ranges
PATIENT SELECTION TOOL by CHEETAH MEDICAL
CHEETAH MEDICAL DIFFERENTIAL DIAGNOSISCase in point: CI, TPRI in context1
Patients with shortness of breath-
differentiating between dyspnea
due to acute heart failure vs. pulm
onary disease
2Patients w
ith low blood pressure
and suspected shock due to:• Septic shock• Cardiogenic shock• H
ypovolemic shock
3Patients treated w
ith Inotropes and/or Vasopressors as a drug titration aid
4G
uidance for fluid resuscitation in Septic patients
Patients undergoing Continuous 5
Renal Replacement Therapy (CRRT)
or Hem
odynamically unstable
patients undergoing hemodialysis
6O
liguric patients
7ARD
S-monitor im
pact of PEEP
CHEETA
H Sensors should be replaced w
ith a new set of sensors after 48 hours of use. Rem
ember to preform
a re-calibration after sensor replacement
and once daily.
SVI ∆ < 10%SVI ∆ ≥ 10%
SVI ∆ ≥ 10%
CONTACT US: Cheetah Medical, Inc. 600 SE Maritime Ave Suite 220 Vancouver, WA 98661 USA Toll free: (+1) 866-751-9097 Tel: (+1) 360-828-8685 Fax: (+1)360-718-8154 Email: [email protected] www.cheetahmedical.com DISCLAIMER: This document and all content in it are for general information purposes only and are not intended to be specific medical advice, medical opinion, diagnosis or treatment as applied to any particular patient’s condition or situation. Please do not rely on tis document or its content as a substitute for the expertise and professional judgment of a physician, pharmacist, nurse, or other healthcare professional. ©Cheetah Medical
CHEETAH Sensors should be replaced with a new set of sensors after 48 hours of use. Remember to preform a re-calibration after sensor replacement and once daily.
R-MRK-26 rev 2
