hemodynamics - the future, what now?

The Future – What Next?

Prof. Brendan Smith & A/Prof. Veronica Madigan.School of Biomedical Science, Charles Sturt University,

Medical School of Notre Dame, Australia,Department of Anaesthesia and Intensive Care,

Bathurst Base Hospital, Bathurst, NSW, Australia.

Conflict of Interest / Financial Considerations

NONE!!

Optimising haemodynamics saves lives.

That’s why we all spend so much time trying to do it!

We measure blood pressure, heart rate and SpO2 on anything that moves...

But there is a big problem with this – We are actually just trying to guess what is

really going on from very limited data...

But none of this tells us DO2 or VO2

“It is impossible to draw conclusions from incomplete

data doctor.”

At the 6th PICC we promised

1)That we would publish the method for rapid bedside measurement of inotropy.

2) That we would build the Smith-Madigan Inotropy Index in to the USCOM for everyone to use.

3) That we would publish the results of the BUSH protocol in septic shock study.

www.learnhemodynamics.com

Real-time measurement of S-M Inotropy Index (“INO”)

Starling Curves and Inotropy Index (SMII)

+inotropy

Left ventricular end diastolic volume

StrokeVolumeIndex

50

25

SV

The Ultimate Diagnostic Device –

The Tricorder

OK, so we’re not at the tricorder stage

BUT…

Using the USCOM 1A with SMII and the

BUSH Protocol for the treatment of

septic shock

resulted in…

TIME TO HD STABILISATION

BUSH Non-BUSH

1.25 hrs 19.9 hrs

(1.26) (12.9)

MORBIDITY

Heart Failure 6.7% 39% 13.7

Respiratory Failure 20% 42.1% 2.92

Renal Failure 8.9% 73.4% 28.6

Tertiary Transfer 4.4% 25% 7.14

BUSH non - OR BUSH

MORTALITY

BUSH Non-BUSH OR

6.7% 38% 13.7

(3/42) (24/63)

NNT = 3.2

What next?

We have to do something similar in paediatric sepsis!!!

We need people to joın us ın a multı-centre RCT...

But it’s too hard to

learn the USCOM!

Its haemodynamics Jim,

but not as we know it!

ThisUSCOM is

astonishing, Bones!!

Echocardiography is for a few expert users

USCOM is for everybody – Learn it in a week,

use it for life!!