Stroke volume; the new vital sign and the effect on micro circulation

Case study: 59 male came in with wound abscess; Pt map is 60 mmHg with 2 positive SIRS criteria; HR 100, Tmax 100.9F. Pt was placed on a non invasive hemodynamic monitoring. CO has been getting worse but SBP is maintaining at 110 mmHg. What’s going on with this patient?

• Flow decrease before pressure decrease
• BP does not change until compensatory mechanism fail (HR, SVR)
• RRT is called only when BP is low

microcirculation of sublingual blood flow. Left: normal | right: poor perfusion

Lets brush up on Frank Starling Law.

The Frank-Starling Law states that the stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction.

flow time in oesophageal Doppler as a predictor of fluid responsiveness

source: Taking Stressors out of Pressors: Vasoactive Drip Titration Made Easy in Acute Care. By Johnson Alexander P

Stroke volume is then the earliest indicator for perfusion that precede the later sign (altered mental status, poor capillary fill time, low urine output, etc. ) Stroke Volume, the new Vital sign,.

Names, dates, and personal identifying details have been changed throughout this website to comply with the Health Insurance Portability and Accountability Act (HIPAA). **