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Pulsecor Presentation
- 15. Physiology Distal aorta Exit of heart Direct Reflected
- 17. Wave Reflections
- 18. Intra-arterial Tracing Incident wave Aortic reflection wave Late reflection wave Dicrotic notch
- 19. Concurrent Signals Intra-arterial tracing Pulsecor suprasystolic waveform
- 20. RWR (reflection wave ratio) = da/ab x 100 RWR = Reflection Wave Ratio (da/ab x 100) PS1 = Suprasystolic pressure wave amplitude dp/dt = Contractility (Peak change in slope of PS1) RWTT = Reflected Wave Transit Time (a-c) SEP = Systolic Ejection Period (a-e) PS1 RWTT a b c d e ab da SEP dp/dt
- 23. Baseline Reflection Wave Ratio vs. Age (n=200 hips) R = 0.491 -1 0 1 2 3 4 5 6 7 8 9 30 40 50 60 70 80 90 RWR > 400% are over 70 years of age Age
- 24. Baseline RWTT* vs. Age (n=200 hips) *surrogate of pulse wave velocity Age .08 .1 .12 .14 .16 .18 .2 .22 .24 .26 .28 .3 30 40 50 60 70 80 90 R = 0.495
- 28. Monitoring Acute Physiological Changes
- 31. Pulsecor Changes Fluid Cardiac Stimulation Ephedrine (inotropic agent) Cardiac Depression Phenyl + Extensive epidural anesthesia Vasoconstrictor Phenylephrine Vasodilator Propofol
- 33. Effect of Propofol (n=200) 0.498 ± .24 8.2 ± 3.8 0.19 ± .03 70 ± 50 45 ± 8 80 ± 12 Propofol 0.0007 0.541 ± .27 PS1 <0.0001 9.4 ± 4.4 dp/dt <0.0001 0.16 ± .03 RWTT <0.0001 130 ± 110 RWR (%) <0.0001 60 ± 12 Pulse Pressure <0.0001 100 ± 11 MAP P Value Baseline
- 36. Vasoconstriction (TKR; n=22) *EA = Epidural anesthesia =0.0378 0.178 ± .03 0.193 ± .02 RWTT <0.0001 149 ± 69 56 ± 30 RWR <0.0001 59 ± 9 77 ± 10 HR <0.0001 84 ± 8 76 ± 8 MAP P Value EA* + Phenyl Propofol
- 40. Cardiac Depression (TKR; n=22) *EA = Epidural anesthesia <0.0001 0.35 ± 0.14 0.52 ± 0.17 PS1 <0.0001 5.4 ± 2 8.6 ± 2.7 dp/dt <0.0001 60 ± 9 77 ± 10 HR NS 48 ± 8 46 ± 9 Pulse Pressure <0.0001 84 ± 8 76 ± 8 MAP P Value EA* + Phenyl Propofol
- 43. Effect of Ephedrine (n=109) 0.62 ± .24 9.4 ± 3.8 0.228 ± .03 24.4 ± 20 46 ± 7.8 63 ± 10 Post Ephedrine <0.0001 0.43 ± .16 PS1 <0.0001 6.2 ± 2.4 dp/dt 0.0002 0.241 ± .03 RWTT 0.005 29.5 ± 18 RWR (%) <0.0001 38 ± 7.6 Pulse Pressure <0.0001 47 ± 7 MAP P Value Post Fluid
- 48. Effect of Fluid (n=109) CVP increased 4 mmHg (mean) 0.431 ± .16 6.2 ± 2.4 0.241 ± .03 29 ± 18 38 ± 7.6 47 ± 7 Post Fluid <0.0001 0.344 ± .12 PS1 <0.0001 5.2 ± 2 dp/dt NS 0.242 ± .04 RWTT NS 31 ± 19 RWR (%) <0.0001 36 ± 7 Pulse Pressure <0.0001 43 ± 6 MAP P Value Pre Fluid
- 50. Snoring dPP = 122%
- 51. Snoring Eliminated dPP = 59%
Notes de l'éditeur
- Go 20090428 0917
- Go 20080815 0856 Go 20080822 1350
- Check AI
- Ward 20080401 1128 Ward 20080401 1143
- Prop2 vs. 2 min post tq up
- Revson 20071108 Base Phenyl 30 min
- Go Exercise Ice 20090421 1102 and 1110
- Redo with baseline
- Revson 20071108 Base Phenyl 30 min
- Skarda 20080509 1247 and 1306 Amplitude corrected
- Go Exercise 20090415 1500 and 1537
- Nolan 20080815 0920 and 0930
- Osborn 20081203
- Osborn 20081203
- Engel 20071018 Baseline