IFAD Hemodynamics Workshop
Joris Lemson takes us from basic to advanced skills in hemodynamic monitoring and therapy
As I sit down, Dr Joris Lemson from The Netherlands, adjusts his characteristic round glasses before starting a tour de force of how blood gets in, out and around. Well explained, succinct cardiovascular physiology is sown between two real clinical cases of sepsis and trauma. All backed-up with a solid PhD in “Cardiovascular Monitoring”.
Starling forces and fluids
- We are all on the steep part of the Starling curve.
- This means our stroke volume will go up if we give fluid.
- This doesn’t mean we SHOULD give fluids
Predicting fluid responsiveness
- CVP may be a means of deciding to STOP giving fluids not START giving fluids.
- Devices do not cure patients, evidence based treatments that are suggested by devices may.
- Choice of device probably not important from those with an evidence base.
- Many, many exclusions to the values measured to predict responsiveness.
Simulation of haemodynamic conditions
- Simulation is not the real world.
- Cardiac output based management challenges can help direct appropriate treatment.
Remember, these “how to manage ...” strategies using devices often put more emphasis on supportive therapies (such as fluids and inotropes) rather than a diagnosis. You can give as much fluid using a PiCCO as you want in shock, but you need to know why they are shocked in the first place. Get a diagnosis - give evidence based treatment. Use devices and support to get to this place. It is not a final destination!