Deltex Medical Basic Presentation

8/4/2019 Deltex Medical Basic Presentation

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1842, Christian Doppler proposed :

the perceived frequency of a knownoscillatory source emitted or reflected by amoving object was directly proportional to

its velocity relative to the observer

The Doppler Principal


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The Doppler Principal


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- Small- Portable

- Enhanced software

- On-screen educational support- H. E. M. compatible

The CardioQ


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Range of Oesophageal ProbesOperating Room,

ITU, Paediatrics and

Adult Nasal Awake


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Probe placement isfacilitated by oral andnasal depth markers

Probe Placement


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Oesophagus

Probe Depth 35to 40 cm

Heart

Venous Signal

Aorta


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Intra-cardiac signal


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Venous signal


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Descending thoracic aorta


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Doppler ApplicationWith each heartbeat, thevelocity of blood flowing throughthe descending aorta is detected

by the Doppler signal anddepicted as a velocity over timewaveform.

Velocity

Time


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SD:Stroke DistanceArea under the Curve

Stroke distance (SD) is the distance moved in centimetres by a column ofblood through the thoracic descending aorta during the systolic part of eachheartbeat.

SD is derived in the CardioQ by measuring the area under the waveformfollower during systole.

The proprietary Deltex algorithm based on a nomogram utilizing the patientsage, height, and weight is used to convert this distance to stroke volume.

Changes in SD measured by the oesophageal Doppler reflect proportionalchanges in SV of blood travelling down the descending thoracic aorta.


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Distance


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Distance to VolumeStroke distance is converted to stroke volume bythe use of a mathematical algorithm.

This computes cardiac output relative to age andBSA (weight and height) directly from the bloodvelocity in the descending aorta.

The algorithm was derived from direct andsimultaneous measurements of cardiac outputusing a pulmonary artery catheter.


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FTc:Flow Time corrected

Flow Time Corrected (FTc) is the time of systolic flow corrected for

heart rate using Bazetts equation. This corrects FT to a HR of 60bpm and thereby removes the confounding effect of changes in HR.

FTc is used as an index of preload. Visually, it

corresponds to the base of the Doppler waveform.

Quantitatively, FTc is displayed in msec.

The two white arrows at the base of the waveform

denote the beginning and the end of systolic flow.

Velocity

Flow TimeTime

Bazett MC. An analysis of the time-relations of electrocardiograms. Heart1920;7:353-364.

Oesophageal Doppler Variables


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PV: Peak Velocity

Peak Velocity (PV) is the velocity of the blood measured at the peak of systoleindicated by the white arrow at the top of the waveform.

PV is an indication of contractility. Visually, it corresponds to the height of thewaveform. Quantitatively, it is expressed as cm/sec.

PV declines with age (approximately 1% perannum of adult life).

NOTE: If there is concern that theoptimal probe position has drifted,confirm peak velocity by manipulatingthe probe to display the highestdetectable peak value.

Velocity

Peak Velocity

Time

Oesophageal Doppler Variables


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Peak Velocity


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Pre-calibrated clinicallyderived nomogram with over300 paired PAC and Dopplerreadings giving accurate SV

and CO results

Extensively clinicallyvalidated in 25 trials of pairedreadings against PAC, Echo

or TD techniques

Real time and rapid display ofSV and CO or CI


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Oesophageal Doppler Probe

Minimally invasivesingle use oesophagealprobe

Probe contains twoindividually calibrated

piezo-electrictransducers forcontinuous emissionand reception of

ultrasound

Unique patientdedicated identificationsystem safeguards

patient data


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FTc: Flow Time correctedThe time of systolic flow corrected to heartrate.

PV: Peak Velocity

The highest velocity of the blood detectedduring systole.

20 yrs: 90120 cm/sec50 yrs: 60 90 cm/sec

70 yrs: 50 80 cm/sec

330 - 360 milliseconds

Normal Ranges

NOTE:Normal Ranges should not be confused with a Physiological Target.


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CardioQ Validation

Noninvasive Monitoring of Cardiac Output in Critically Ill PatientsUsing Transesophageal Doppler

Pulmonary Artery Catheter Vs. Esophageal Doppler Monitor:Measurement of Cardiac Output and Left Ventricular Filling DuringCardiac Surgery

Validation of the esophageal Doppler Cardiac Function Monitor withthe Standard Thermodilution Method during Liver Transplantation

B. Valtier, B. CholleyAM J CRIT CARE MED 1998;158:77-83

CJ DiCorte. P LathamANAES ANALG 1999:88; SCA1-SCA126

M Nakatsuka, R A FisherANAES ANALG 1997; 84: SCA1-SCA127


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Fluid Optimisation Perioperative Plasma Volume Expansion Reduces the

Incidence of Gut Mucosal Hypoperfusion During CardiacSurgery

Intraoperative Intravascular Volume Optimisation andLength of Hospital Stay after Repair of Proximal FemoralFracture: Randomised Controlled Trial

Goal-directed Intraoperative Fluid Administration ReducesLength of Hospital Stay after Major Surgery

M. Mythen, A. Webb ARCH SURG/VOL 130 APR1995

S. Sinclair, S. James, M Singer BMJ VOL 315. OCT 1997

T. J. Gan, A. Soppitt ANESTHESIOLOGY, V97, No4. OCT2002


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Frank-Starling Curve

200ml 200ml

Stroke Volume

Filling


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cardiac

cardiac

abdo-pelvic

#NOF

#NOF

% reduction in hospital stay c/f control

Summary of Doppler studies

Mackay (174)

Mythen (60)

Gan (100)

Venn (90)

Sinclair (40)


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generalcardiac

abdo/vascabdo/vascabdo/vasc/traumacardiaccardiac

abdo-pelvic#NOF#NOF

% reduction in hospital stay c/f control

Summary of All Studies


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Hypovolaemia


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Hypovolaemia +200ml Fluid


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Hypovolaemia +400ml Fluid


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Fluid Optimised Patient (+600ml)

5.9 78 357


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Thank You

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Deltex Medical Basic Presentation