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European Society for Computing and Technology in Anesthesia and Intensive Care 2010 Non-invasive pulse contour cardiac output by Nexfin technology. Johannes J. van Lieshout, Wilbert A. Wesselink, Berend E. Westerhof Special Medical Care, Dpt Internal Medicine - PowerPoint PPT Presentation
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European Society for Computing and Technologyin Anesthesia and Intensive Care 2010
Non-invasive pulse contour cardiac output by Nexfin technology
Johannes J. van Lieshout, Wilbert A. Wesselink, Berend E. WesterhofSpecial Medical Care, Dpt Internal Medicine
Laboratory for Clinical Cardiovascular Physiology, Center for Heart Failure Research
Academic Medical Center Amsterdam
Casus
Casus
• Continuous Finger Arterial Pressure
• From Finger Pressure to Flow
Non-invasive pulse contour cardiac output - Outline
Clinical standard
9/00 JJvL05/06 JJvL
late 1970s: Non-Invasive Blood pressure Device (NIBD)
9/00 JJvL05/06 JJvL
Pressure as Function of Location in Arterial Tree
Nichols & O’Rourke 2005
Finger pressure
Portapres
Finometer
NexFin
Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat
Blood Pressure - Volume Clamp
Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat
Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff
Blood Pressure - Volume Clamp
Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat
Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff
Changes in diameter opposed by a fast pressure servo controller that changes finger cuff pressure
Blood Pressure - Volume Clamp
Bogert LW, Van Lieshout JJ. Exp Physiol 2005;90(4):437-46
Blood Pressure - Volume Clamp
Diameter of an artery under a finger cuff is kept constant (clamped) in spite of changes in arterial pressure during each heart beat
Detection of arterial diameter by an infra-red plethysmograph built in the finger cuff
Changes in diameter opposed by a fast pressure servo controller that changes finger cuff pressure
Expert system (Physiocal ) defines and maintains the correct diameter at which the finger artery is clamped
Bogert LWJ et al. Anaesthesia, 2010
Martina J et al. Revision
Martina J et al. Revision
Martina J et al. Revision
• Continuous Finger Arterial Pressure
• From Finger Pressure to Flow
Non-invasive pulse contour cardiac output - Outline
Windkessel model 1-3
The 3 element Windkessel model is used to determine the afterload (Zin) of the heart for every beat
Windkessel model 2-3
Windkessel model 3-3
Nexfin CO-Trek
age
gender
height
weight
Z0
Cw
stroke volume
cardiac output
heart rate
RpPressure
MAP
Zin
05/06 JJvL
Harms MPM, Wesseling KH, Pott F, Jenstrup M, Van Goudoever J, Secher NH, Van Lieshout JJ. Clin Sci 1999 Jellema WT, Wesseling KH, Groeneveld AB, Stoutenbeek CP, Thijs LG, Van Lieshout JJ. Anesthesiology 1999
Nissen P, Van Lieshout JJ, Novovic S, Bundgaard-Nielsen M, Secher NH. Liver Transplantation 2009
Bogert LW, Wesseling KH, Schraa O, Van Lieshout EJ, De Mol BA, Van GJ, Westerhof BE, Van Lieshout JJ. Anaesthesia 2010
• Continuous Finger Arterial Pressure
• From Finger Pressure to Flow
Non-invasive pulse contour cardiac output - Outline
Continuous Cardiac Output
Tissue Perfusion & Oxygenation
Perspective