Rheumatoid arthritis
Rheumatoid Arthritis = autoimmune disorder characterised by a bilateral, peripheral symmetrical inflammatory arthritis with a number of other systemic associations. Multisystem disease which can range from mild -> severe
Septic cardiomyopathy
Reviewed and revised 11 November 2016 OVERVIEW Septic cardiomyopathy is a common feature of severe sepsis syndromes and results in impaired intrinsic cardiac contractility First described by Parker et al in 1984 Incidence varies in studies, most report 20-60% incidence…
Immunomodulatory Agents in Sepsis
Immunomodulatory Agents in Sepsis: huge research area; no definitive therapies available; some research very controversial
Catecholamine excess, Beta Blockade and Critical Illness
Catecholamine excess, or 'sympathetic overload', may be harmful in critically ill patients, including those with septic shock. Catacholamine excess is associated with specific conditions such as Takotsubo cardiomyopathy
PAC Literature Summaries
Pulmonary Artery Catheter (PAC) Literature Summaries
Pulmonary haemorrhage after PAOP measurement
OVERVIEW a life threatening time-critical emergency pulmonary artery rupture caused by inflation of the pulmonary artery catheter (PAC) balloon during ‘wedging’ (measurement of the pulmonary artery occlusion pressure) some experts advise against measuring PAWP because of the risk of pulmonary…
Troubleshooting PAC measurement
Troubleshooting Pulmonary Artery Catheter measurement
Pulmonary Artery Wedge Pressure
PAOP or PAWP is pressure within the pulmonary arterial system when catheter tip ‘wedged’ in the tapering branch of one of the pulmonary arteries
in most patients this estimates LVEDP thus is an indicator of LVEDV (preload of the left ventricle)
Mixed venous oxygen saturation (SvO2) monitoring
USES measurement of oxygenation saturation from mixed venous blood (SvO2) in the pulmonary artery requires Pulmonary Artery Catheter insertion in most clinical settings DESCRIPTION measures the end result of O2 consumption and delivery METHOD OF INSERTION AND/OR USE O2 flux…
Central venous oxygen saturation (ScvO2)
Central venous oxygen saturation (ScvO2) surrogate for SvO2 thus provides a surrogate measure of oxygen flux, reflecting the balance between oxygen delivery (DO2) and consumption (VO2).
SvO2 vs ScvO2
SvO2 vs ScvO2: used as a measure of the adequacy of total body O2 delivery; can be both displayed continuously
Early Goal Directed Therapy in Septic Shock
EGDT: Within 6 hours of presentation to the Emergency Department intensive monitoring of specific circulatory parameters with the aggressive management of 5 key parameters to specified targets to optimise oxygen delivery to tissues.