tailieunhanh - Báo cáo y học: "Applying logic to pulmonary artery catheter use"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Applying logic to pulmonary artery catheter use. | Available online http content 12 4 421 Letter Applying logic to pulmonary artery catheter use Horst E Kunig1 Michael R Pinsky2 and Lothar Engelmann3 1PO Box 192 Saltsburg PA 15681-0192 USA 2Critical Care Medicine Bioengineering Cardiovascular Disease and Anesthesiology 606 Scaife Hall 3550 Terrace Street Pittsburgh PA 15261 USA 3University of Leipzig Zentrum fuer Innere Medizin Abteilung Intensivmedizin Liebigstrasse 20 04103 Leipzig Germany Corresponding author Horst E Kunig kunig@ Published 7 July 2008 This article is online at http content 12 4 421 2008 BioMed Central Ltd Critical Care 2008 12 421 doi cc6928 See related journal club critique by Mansour et al. http content 12 1 301 Mansour and colleagues recommend not routinely using the pulmonary artery catheter to guide hemodynamic management in the intensive care unit because the perceived benefits are largely intangible 1 . Pulmonary artery catheter monitoring of the right ventricular ejection fraction RVef and of the right ventricular end-diastolic volume EDV however reflects powerful yet underutilized relationships that assess right ventricular performance. Since the cardiac output equals the product of the RVef the EDV and the heart rate one can assess the RVef to EDV relations as direct measures of right ventricular performance. A series of RVef EDV and heart rate combinations can give the same cardiac output Figure 1 monitoring or targeting cardiac output alone ignores this reality. For example in hypovolemia the EDV is low and the RVef is increased whereas in right ventricular failure the opposite is true. Furthermore resuscitation from hypovolemia will increase the EDV and decrease the RVef 2 while reversal of cor pulmonale will decrease the EDV and increase the RVef. No monitoring device other than the pulmonary artery catheter can continually assess these variables. These concepts are often used in the cardiac surgery suite but are rarely codified