[CK] LVAD parameter review. [ ] tree !!

Vital(BP): hypo, hyper.
PEx(JVP): volume status

--------------------------------
1st. PI(3-7)= contractility and volume status(high volume only cause high PI)
overload = high PI.
low volume = low PI. (=low volume = low preload = RV failure, arrhythmia same thing)

HTN = low PI
low BP = low PI.
(only overload cause high PI = with high preload, but otherwise, BP, volume => cause low PI)

2nd. Flow(4-6)
overload,

3rd. Power(surge = only thrombus, 4-6)

hypotension route (BP)

=> high VADFL = vasodilator, sepsis = R/O

=> low VADFL(most common)  with high JVP => RV failure, PE/tamponade, pneumothorax

                                                                              , then adjust LVAD(higher)

                                                with low JVP => volume depletion, arrhythmia(bleeding, volume 

                                                                                                                             depleted) 

1>BP  (2>FLOW 2.5>PI) 3>JVP

normotensive 

=> high VADFL(power) = pump thrombosis

=> High + high PI = more overload, higher contractility.

=> low FL and LO PI. = HTN or suction. 

      low PI = same as low flow model. (RV failure like with JVP) 

hypertension

=> low Flow, low PI. 

=> without exam? 

=> with exam? 

=============> guide line 

cf>

High Po(Flow), Low PI, fluctuation speed = special occasion = pump thrombosis, hypotension

High Po(Flow) high PI = Fluid overload

Low Po(flo), low PI = HTN

Low Po(flow), high PI = suction event. or HTN . SO HTN => NOT RELATED TO PI !!!?? 

Evaluation^[3]

• Assess perfusion and general state (mental status, skin temp/color, capillary refill, etc)
  • LVADs are preload dependant - if symptoms of hypoperfusion, give fluid blous
• HR measured via ECG or auscultation (may be difficult secondary to pump noise)
• Get 12-lead ECG on all LVAD patients
  • Demonstrates primary cardiac disease^[6]
  • Generally, VAD does not influence underlying cardiac rhythm
• Bedside echo if able, formal echo if available
• Blood pressure measured with manual BP cuff and Doppler ultrasound - MAP is identified when constant flow is heard
  • MAP should be 70-90 mmHg
  • Can also monitor with arterial line
• Basic labs (CBC, CMP, Coags) should be obtained on all LVAD patients
• LDH elevation over 1,150 IU/L suggestive of pump thrombosis^[7]
  • Approximate sensitivity of ~80% and specificity of 90%
  • Hemolysis within thrombosed pump releases LDH
• Assess LVAD status
  • Auscultate for pump noise
  • Device parameters (found on controller)
    • Pump speed - varies by device - 2,000-10,000 RPM
    • Power - normal 4-6 Watts
    • Flow - normal 4-6 L/min
    • Pulsatility Index (PI) - normal 1-10
      • Measures magnitude of pulsatile flow provided by native cardiac contractions
      • Higher PI = less LVAD support
  • Clinical status more important than LVAD parameters