Usporedba statičnih i dinamičkih hemodinamskih parametara u procjeni cirkulirajućeg volumena

master's thesis

• Title (english): Comparison between static and dynamic hemodynamic parameters in the assessment of the circulating blood volume
• Author: Antonio Bulum
• Mentor: Mladen Perić (mentor)
• Committee member: Ante Sekulić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Mladen Perić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2015-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Procjena cirkulirajućeg volumena jedan je od najvažnijih, ali i najtežih postupaka kod liječenja pacijenata hospitaliziranih na jedinici intenzivnog liječenja. Još od početaka intenzivnog liječenja procjena intravaskularnog volumena s ciljem adekvatne nadoknade volumena tekućinama bila je u fokusu liječnika, pa ipak brojna istraživanja pokazuju da samo polovica hemodinamski nestabilnih pacijenata adekvatno reagira na nadoknadu volumena. Tlakovi punjenja srca, poput centralnog venskog tlaka te plućnog uklještenog kapilarnog tlaka, tradicionalno se koriste u procjeni cirkulirajućeg volumena i kao vodilja pri davanju tekućina. Međutim, studije provedene zadnja tri desetljeća uniformno pokazuju da tlakovi punjenja srca nisu adekvatni u procjeni volumena i odgovora na volumnu nadoknadu. Odnosno, centralni venski tlak nije adekvatan pokazatelj cirkulirajućeg volumena kod hemodinamski nestabilnih pacijenata. Sukladno tome, u zadnjem desetljeću, razvijen je niz minimalno invazivnih i neinvazivnih sustava monitoringa koji procjenu cirkulirajućeg volumena vrše mjereći dinamičke parametre. Ovi sustavi kontinuirano prate promjene udarnog volumena i tlaka pulsa mehanički ventiliranih pacijenata temeljem analize krivulje tlaka pulsa i ultrazvučnih Doppler metoda te na taj način vrše procjenu cirkulirajućeg volumena i odgovora pacijenta na nadoknadu volumena. Iako rezultati dosada provedenih istraživanja pokazuju obećavajuće rezultate, potreban je veći broj studija na većem broju pacijenata za kvalitetnu ocjenu dinamičkih parametara u procjeni cikulirajućeg volumena.

Abstract (english)

The assessment of the circulating blood volume is one the most important, but also the most difficult procedures when treating patients hospitalised at the intensive care unit. Since the beginning of intesive care treatement the assessment of the intravascular volume with the goal of adequate fluid management has been in the centre of modern medicine, yet only half of hemodynamically unstable patients respond to a fluid challenge. Cardiac filling pressures, such as central venous pressure and pulmonary capillary wedge pressure, have been traditionally used to assess the circulating blood volume and guide fluid management. However, studies performed during the past three decades demonstrated that cardiac filling pressures are unable to adequately assess the circulating volume and predict fluid responsiveness. Or said otherwise, static parameter central venous pressure does not provide a valid assessment of the circulating blood volume of hemodynamically unstable patients. In accordance to that, a series of minimally invasive and noninvasive monitoring technologies to assess the circulating volume using dynamic parameters has been developed. These systems measure the changes in stroke volume and pulse pressure of mehanically ventilated patients continuously using the pulse contour analysis and Doppler methods to assess the circulating volume and predict fluid responsiveness. Although the results of studies conducted so far show promissing results, further research with more patients is needed in order to adequatley evaluate the dynamic parameters in their ability to assess the circulating blood volume.

• Keywords: cirkulirajući volumen; centralni venski tlak; varijacija udarnog volumena; varijacija tlaka pulsa.
• Keywords (english): circulating volume; central venous pressure; stroke volume variation; pulse pressure variation.
• Language: croatian
• URN:NBN: urn:nbn:hr:105:668818
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-08-08 08:20:15