• B B Sramek.
• CardioDynamics International Corporation, Irvine, CA 92718, USA.
• Ann Acad Med Singap. 1994 Nov 1;23(6 Suppl):26-32.

AbstractThe systemic haemodynamic state is expressed by paired values of Mean Arterial Pressure (MAP) and Stroke Index (SI), varying for every heart beat. Algebraic product of SI and Heart Rate (HR) then defines the perfusion-related Cardiac Index (CI), which is the dynamic modulator of Oxygen Delivery Index (DO2I). Since MAP, SI and CI can each attain a normal, infranormal or supranormal level, there is a total of 9 haemodynamic states, plus 3 CI states. A patient with normal haemodynamics has MAP, SI and CI within his/her normal ranges. The remaining 8 abnormal haemodynamic states and 2 abnormal CI states are the vectorial end-result of a combination of abnormal levels of haemodynamic modulating pathways, i.e., intravascular volume, inotropy, vasoactivity and chronotropy. The Haemodynamic Management Chart (HMC) identifies the inter-relationship between the deviations in volume, inotropy and vasoactivity responsible for the observed haemodynamic state in respect to the desired haemodynamic state (Haemodynamic Therapeutic Goal [HTG]). The deviation in CI from its normal level then determines the deviation in chronotropy. In contrast to current management methodology of trial and error, the HMC enables the clinician to continuously manage a patient's haemodynamics within the HTG. This is expected to produce a shorter therapy and improved outcome.

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