esCCO Information vol.

Intuitive Screen withHemodynamics Graph
Improving the standard of
non-invasive hemodynamic
monitoring
Visualizing Volumetric
Information

making in hemodynamic management.

For quality patient care, comprehensivechange while imaging the Frank-Starling

management of different hemodynamic

curve, and help to objectively determine

parameters is crucial.

the optimal therapeutic strategy based on

Nihon Kohden’s Hemodynamics Graph

the Forrester Classification1).

This new tool helps clinicians easily see
the direction and trend of hemodynamic

provides a more intuitive approach todiagnostic and therapeutic decision

New Hemodynamics Graph
The Hemodynamics Graph is a new

Cardiac index (L/min/m2)

NormalNormal cardiac function

2.2

Pulmonary edema

monitoring tool which shows overall
hemodynamic information. A trendgraphat the top and two target graphs below
show the relationship of two hemodynamic

Serious heart failure
Hypovolemic shock
00parameters.

Cardiogenic shock

18
PCWP (mmHg)

This screenshot of a Hemodynamics Graphshows the time course of hemodynamic
response through the administration ofFigure 1 : Forrester Classification

200 mL of glycerin.

Trend Graph

Target Graph

Figure 2 : Hemodynamics Graph

Target Zone

3

Hemodynamics Graphis available
on following
NIHON KOHDEN
patient monitors

esCCO Information vol.3
Early Decision
Making in
Goal Directed Fluid
Management

The yellow bar below the Trendgraph in

CVP target graphs can support therapy

Figure 2 indicates the time interval of theaccording to the guidelines for initial

Target Graphs below. The yellow bar starts

resuscitation of severe sepsis and septic

with a purple triangle which represents

shock6). Intermittent invasive parameters

the Event Mark recorded at the time ofsuch as cardiac output by bolusintervention.

thermodilution and pulmonary wedge

In this Hemodynamics Graph screenshot,pressure can also be used for the Target

the traces on both Target Graphs show

Graphs.

that hemodynamics is falling within theThe Hemodynamics Graph can open up

Target Zones (red boxes) in response to thenew ways to manage hemodynamics for all

administration of glycerin.

care levels more efficiently and effectively.

Target Graph Features◦Preload parameters such as CVP and PPVon the X axis
◦C ardiac function parameters such as
cardiac index on the Y axis
◦Brightness level of the traces and plots
shows hemodynamic change over time◦Red target zones show target areas oftreatment
References1）	Forrester JS et al. Medical therapyof acute myocardial infarction
by application of hemodynamic
subsets. N Engl J Med 1976; 295:
1356-14132）	Wakeling HG et al. Intraoperative
oesophageal Doppler guided
fluid management shortens
postoperative hospital stayafter major bowel surgery. Br J
Anaesth 2005; 95: 634-423）	Mayer J et al. Goal-directed
intraoperative therapy basedon autocalibrated arterialpressure waveform analysis
reduces hospital stay in high-risk
surgical patients: a randomized,
controlled trial. Crit Care 2010;
14: R184）	Sugo Y et al. A Novel Continuous
Cardiac Output Monitor Basedon Pulse Wave Transit Time. Conf
Proc IEEE Eng Med Biol Soc 2010:2853-65）	Yamada T et al. Verificationof a non-invasive continuous
cardiac output measurement
method based on the pulsecontour analysis combined withpulse wave transit time. Eur J
Anaesthesiol 2010; 27 (Suppl 47):
3AP5-96）	Dellinger RP et al. Surviving
Sepsis Campaign: Internationalguidelines for management ofsevere sepsis and septic shock:2008. Crit Care Med 2008; 36:
296-3278754 SP61-037A ’16. 7. CLB. A◦T ext-entry for prescribing necessarytreatments

Various Combinations ofHemodynamic Parameters

8 mmHg

CVP

8-12 mmHg
65 mmHg

MAP

Give ﬂuid challengesof crystalloids
or colloids

Administer
vasopressors

65 mmHg
Next Step

Much evidence supports the idea thatgoal-directed fluid management guided
by several hemodynamic parameters willFigure 3 : CVP/MAP target graph and initialresuscitation protocol in severe sepsis andseptic shock

reduce postoperative hospital stay andcomplications2) 3).
The Hemodynamics Graph displays
necessary parameters for fluid optimization
therapy in a visually intuitive manner andcan help to improve the standard of carewith hemodynamic monitoring.
The Target Graphs can show different

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hemodynamic parameters for different
clinical conditions. For example, target
graphs for PPV and esCCO (a non-invasive
continuous cardiac output monitoring
method using ECG and pulse oximeterwaveform4) 5)) provide minimally invasive
hemodynamic monitoring for fluid
management. Or, blood pressure andFigure 4 : PCWP/CI target graph