- See: -
CVP -
SG CATH -
Afterload - Frick method - 3.5-5.5 L/min;; Cardiac Index: 2.8-3.2 L/min/m sqd;; - average normal cardiac index is 3.5 l/min/m sq, and 95% of normal individuals have indices in the range of 2.1 to 4.9 l/min/m sq; - determinants of cardiac output: -
HR: in general should be maintained between 80-110 - for slower rates may use low dose:
Dopamine or
Isoproterenol -
Preload: w/ incr Preload,
CO will rise on the Starling Curve; - usually
PCWP may be increased to 18-20 mm Hg to optimize CO; (most hearts, even sick hearts, will tolerate this pressures) - it is not necessary to increase filling press. if
CO is OK; (many relatively healthy Post Op hearts may pump well at 10-15) - for the sick heart (prior infarcts and extensive heart surgery) - filling pressures greater than 18 to 20 mm Hg may be required; - for these hearts, individual Starling Curve must be determined and volume administration must be turned off as curve flattens; - note: w/ overdistension, tension (and O2 consumption) increases dramatically; tension is major determinant of O2 consumption;
