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sv svv co sv MAP. Ensuring adequate perfusion. HPI: Detecting Hypotension.
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Objectives. IDENTIFY misconceptions regarding hypotension. DISCUSS the importance of hypotension and its consequences if not treated. DEFINE the HPI parameter and its components..
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Hypotension: MAP <65 mmHg for 1 minute. Use of minimally invasive system, provides access to advanced hemodynamic parameters (CO, SV, SVV, & SVR) that allow you to evaluate hemodynamic instability and guide appropriate treatment. 88% of patients with arterial lines still experienced hypotensive events. Proactive Intraoperative Hypotension Management.
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Why should we care?.
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Why should we care?.
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ADEQUATE BLOOD PRESSURE MAY NOT MEAN ADEQUATE PERFUSION.
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O minutes 1 to 5 minutes 6 to 10 minutes 11 to 20 minutes minutes 6 1.5 2 Adjusted Odds Ratio 2.5 Acute Kidney Injury Cardiac Complication Myocardial Injury.
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DEVICES. Arterial line. FLOTRAC. Finger Cuff. CLEARSITE.
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What is HPI ?. Hypotension Prediction Index. Provides you with information regarding the likelihood of a patient trending toward a hypotensive event. Range from 0-100. Gives a new number every 20 seconds, with higher numbers indicating a higher likelihood of a hypotensive event. Multiple studies have shown that Acumen HPI software: Achieves statistically significant reduction of hypotension when combined with a treatment protocol in noncardiac surgery vs. standard of care. Acumen HPI software has demonstrated a reduction in the duration of IOH by 57%. Demonstrates superior predictive abilities for hypotension than common hemodynamic parameters such as cardiac output (CO), stroke volume (SV), and changes in mean arterial pressure (MAP)..
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100 90 80 70 60 50 40 30 20 10 7 minutes .6 .43 .N Tme 100 80 20 — MAP — HPI.
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Contractility Contractility 160 features Stroke volume peripheral effects Afterload Compliance Vascular tone Full cardiac cycle aortic compliance.
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Mwards Lif esciences MAP dP/dt 'f 00 70 515 Change SVR •co 3.5 • SV 55 16 1486 104/73 (82).
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Mwards Lif esciences MAP dP/dt 'f 00 70 515 Change SVR •co 3.5 • SV 55 16 1486 104/73 (82).
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Preload. Afterload. Contractility. *Let MS. Eadyn 1.2 '/dt Arterial Elastæxe (.PMSVV).
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Start Evaluate: dPldT increase? Elastance normalised? HPI 50-85 Diagnose cause or MAP<65 Advice: Start treatment < 2 minutes Two criteria present SVR SW t Yes Advice: Most likely cause vasoplegia No Two criteria present Eadyn t SW t sv Yes Advice: Most likely cause hypovolemia No If no condition is satisfied treat hypotension without advise No Three criteria present SVR sw = sv Yes Advice: Most likely cause reduced LV contractility Treatment started by anesthetist.
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Low Ea (10/15) = 0 67 PPV 25% ppv 10% sw 15% sw 15% High Ea (25/15) = 1.67 Volume.
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Davies, S. (2021). Managing Intraoperative Hypotension with a Predictive Parameter Part 2. [Video]. https://www.youtube.com/watch?v=SzfFnF4j624 Edwards Life Sciences. (2021). Acumen Hypotension Prediction Index Software. Retrieved from https://www.edwards.com/gb/devices/decision-software/hpi Edwards Life Sciences. (2021). Edwards Clinical Education. Retrieved from https://www.edwards.com/gb/clinicaleducation Edwards Life Sciences. (2021). Intraoperative Hypotension Matters. Retrieved from https://www.edwards.com/gb/therapies/hypotension-management# Edwards Life Sciences. (2021). Methods for Assessing Fluid Responsiveness. Retrieved from https://educationgb.edwards.com/fluid-responsiveness-in-the-critically-ill-patient-svvplr/72010# Khanna, A. (2021). Managing Intraoperative Hypotension with a Predictive Parameter Part 1. [Video]. YouTube. https://www.youtube.com/watch?v=Jp9-5uqWDeo&t=685s.