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An evidence-based guide to hemodynamic monitoring procedures and patient care, Hemodynamic Monitoring: Evolving Technologies & Clinical Practice describes invasive, non-invasive, and minimally invasive techniques in monitoring blood pressure and oxygen levels within the circulatory system. It provides a clear, illustrated discussion of the anatomy and physiology related to hemodynamics, explains the technologies involved in each measurement, and includes quick-reference tables of normal and abnormal values. Written by cardiovascular nursing expert Mary E. Lough, Hemodynamic Monitoring is a detailed, comprehensive text designed for critical care nurses and respiratory therapists.

  • Case Studies in each clinical chapter include a patient scenario with assessment details, allowing you to envision real-life patient care and prepare for adverse outcomes or complications.
  • Coverage of patient safety includes a discussion of important measures that will help you provide safe and effective patient-centered care.
  • UNIQUE! Coverage of patient comfort includes a discussion of methods to increase patient comfort during invasive procedures.
  • Clinical Reasoning Pearls provide practical advice from experts and describe how to implement a procedure or improve patient care.
  • A table of Important Values and Formulas is located inside the back cover for quick and easy reference.



Published by
Published 16 February 2015
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EAN13 9780323293679
Language English
Document size 10 MB

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Hemodynamic Monitoring
Evolving Technologies and Clinical Practice
Mary E. Lough, PhD, RN, CNS, CCRN, CNRN, CCNS
Critical Care Clinical Nurse Specialist, Stanford Health Care, Clinical Assistant Professor, Stanford University, Stanford, California
Table of Contents
Cover image
Inside Front Cover
Title page
Preface and Acknowledgments PART 1: Fundamentals of Hemodynamic Monitoring
1: Physiologic Principles of Hemodynamic Monitoring
Circulation of the Blood and the Birth of Hemodynamics
Cardiac Cycle
Cardiac Valve Movements
Pressure Volume Loops
Stroke Volume and Ejection Fraction
Cardiac Output
Blood Circulation
Arterial Vascular Dynamics
Venous Vascular Dynamics
Blood Vessel Pressure, Flow, and Resistance across the Vasculature
Regulation of Blood Pressure
Neurohormonal Regulation of Blood Volume
2: Physical Assessment and Hemodynamic Monitoring
Key Physiologic Concepts
General Appearance
Physical Assessment
3: Arterial Pressure Monitoring
Historical Milestones
Key Physiologic Concepts
Clinical Procedure and Technical Considerations
Baseline Blood Pressure
4: Central Venous Pressure Monitoring
Key Physiologic Concepts
Measurement of Central Venous Pressure
Central Venous Pressure Waveforms
Establishing Baseline—Normal Pressure Ranges
Assessment of Central Venous Pressure Readings
Controversies Regarding Central Venous Pressure
Troubleshooting Primary Complications of CVP Lines
5: Pulmonary Artery Pressure and Thermodilution Cardiac Output Monitoring
Historical Milestones
Key Physiologic Concepts
Clinical Procedures and Technical Considerations
Measurement Method
Waveform Interpretation
Measuring Thermodilution Cardiac Output
Interpretation of Data
6: Oxygenation and Acid–Base Balance Monitoring
Historical Milestones
Basics in Pulmonary Gas Exchange: External Respiration
Basics in Cellular Gas Exchange and Metabolism: Internal Respiration
Evaluation of Pulmonary Blood Flow and Gas Exchange
Oxygenation Monitoring
Arterial Blood Gas
Ventilation Measures and Assessment of Partial Pressure of Arterial Carbon Dioxide and End-Tidal Carbon Dioxide
The Acid–Base Balance
Arterial Blood Gas—Knowledge Application
7: Venous Oxygen Saturation Monitoring
Physiology of Oxygen Delivery and Consumption
Mixed Venous Oxygen Saturation
Clinical Applications of Monitoring of Saturation of Venous Oxygen
Central Venous Oxygen Saturation
Relationships between Oxygen Delivery and Oxygen Consumption
8: Capnography Monitoring
Respiratory Physiology
Carbon Dioxide Measurement Devices
Waveform Analysis
Clinical Application
Specialty Applications
9: Vasoactive Medications
Adrenergic Receptors
Vasopressor Medications
Vasodilator Medications
Positive Inotropes
Combined Alpha–Beta Blockers
Clinical Implications
PART 2: Noninvasive and Minimally Invasive Hemodynamic Monitoring
10: Doppler Hemodynamic Monitoring
Historical Milestones
Key Physiologic Concepts
Doppler Background
Clinical Applications of Doppler Monitoring
Doppler Monitoring Devices
Transcutaneous Doppler Monitoring
Esophageal Doppler Monitoring
Clinician Education and Training
Future Developments
11: Ultrasonography-Based Hemodynamic Monitoring
Image Acquisition and Interpretation of Structures in Ultrasonography
Cardiac Assessment
Pulmonary Edema or Fluid Overload Assessment
Vascular Assessment
12: Arterial Waveform and Pressure-Based Hemodynamic Monitoring
Historical Milestones
Physiology of Arterial Pressure and Pulse Contour
From the Arterial Line to Noninvasive Finger Cuff
Clinical Utility
Clinical Procedure and Technical Considerations
Patient Care Considerations
13: Implantable Hemodynamic Monitoring
Historical Milestones in Internal Hemodynamic Monitoring
Heart Failure Management
Implantable Hemodynamic Monitoring
Using Implantable Hemodynamic Monitoring
Management Considerations
PART 3: Clinical Applications of Hemodynamic Monitoring
14: Hemodynamics of Mechanical Ventilation and Acute Respiratory Distress Syndrome
Physiologic Breathing
Circulating Blood Volume
Positive Pressure Ventilation
Positive End-Expiratory Pressure
Hemodynamic Alterations in Acute Respiratory Distress Syndrome
Ventilation Mode and Hemodynamic Impact
Hemodynamic Monitoring and Mechanical Ventilation
Hemodynamic Changes with Ventilator Liberation
15: Hemodynamics of Mechanical Circulatory Support
Historical Milestones
Categories of Mechanical Circulatory Support
Short-Term Mechanical Circulatory Support Therapy
Intermediate-Term Mechanical Circulatory Support Therapy
Long-Term Mechanical Circulatory Support Therapy
SynCardia Total Artificial Heart
Future Direction
16: Hemodynamic Management Following Cardiac Surgery
Impact of Cardiac Surgery on Hemodynamics
Postoperative Hemodynamics in Patients with Normal Ventricular Function
Hemodynamics in Systolic Dysfunction: The Volume Overloaded Ventricle
Hemodynamics in Diastolic Dysfunction: The Pressure Overloaded Ventricle
Important Conditions after Cardiac Surgery: Bleeding, Tamponade, and Ventricular Failure
17: Hemodynamic Management of Heart Failure and Cardiogenic Shock
Subcategories of Heart Failure
Signs and Symptoms of Acute Decompensated Heart Failure and Cardiogenic Shock
Treatment of Acute Decompensated Heart Failure and Cardiogenic Shock
18: Hemodynamics of Acute Right Heart Failure and Pulmonary Hypertension
Historical Perspective
Key Physiologic Concepts
Signs and Symptoms
Laboratory Tests for Right Heart Failure
Right Ventricular Diagnostic Tests
Treatment of Right Heart Failure
Connections Between Right Heart Failure and Pulmonary Hypertension
Hemodynamics of Pulmonary Hypertension
19: Hemodynamic Management in Hypovolemia and Trauma
Etiology of Traumatic Injuries
Key Physiologic Concepts
Trauma Resuscitation Phase
Critical Care Phase
20: Hemodynamics of Sepsis
Historical Milestones
Epidemiology of Sepsis to Septic Shock
Sepsis Pathophysiology
Sepsis Definitions
Hemodynamics of Sepsis: Variability in Oxygen Delivery, Vascular Tone, and Arterial Volume
Managing the Hemodynamics of Sepsis, Severe Sepsis, and Septic Shock
21: Hemodynamic and Intracranial Dynamic Monitoring in Neurocritical Care
Historical Milestones
Central Nervous System Multimodality Monitoring
Key Physiologic Concepts
Central Nervous System Measurement Methods
Intracranial Pressure Monitoring and Cerebral Perfusion Pressure Monitoring
Brain Oxygenation
Cerebral Blood Flow
Adjunctive Measurements
Hemodynamics and Intracranial Dynamics Monitoring in Selected Neurologic Injury and Illness
22: Goal-Directed Hemodynamics
Vascular Tone
Goal-Directed Therapy
Historical Milestones
Shock and Oxygen Delivery
Volume Resuscitation Assessment
Oxygen Delivery and Oxyhemoglobin Dissociation
Goal-Directed Therapy and Protocols
Hemodynamic Equations and Normal Values
Case Studies and Case Examples