Optimising hemodynamics saves lives. That’s why we all spend so much time trying to do it! We measure blood pressure, heart rate and SpO2 on anything that moves... But there is a big problem with this – We are actually just trying to guess what is really going on from very limited data

1. The Future – What Next?
Prof. Brendan Smith & A/Prof. Veronica Madigan.
School of Biomedical Science, Charles Sturt University,
Medical School of Notre Dame, Australia,
Department of Anaesthesia and Intensive Care,
Bathurst Base Hospital, Bathurst, NSW, Australia.

2. Conflict of Interest / Financial Considerations
NONE!!

3. Optimising haemodynamics
saves lives.
That’s why we all spend so much time
trying to do it!
We measure blood pressure, heart rate
and SpO2 on anything that moves...
But there is a big problem with this –
We are actually just trying to guess what is
really going on from very limited data...

4. But none of this tells us DO2 or VO2

6. “It is impossible to
draw conclusions
from incomplete
data doctor.”

7. At the 6th PICC we promised
1)That we would publish the method for rapid
bedside measurement of inotropy.
2) That we would build the Smith-Madigan
Inotropy Index in to the USCOM for everyone
to use.
3) That we would publish the results of the
BUSH protocol in septic shock study.

8. www.learnhemodynamics.com

9. Real-time measurement of
S-M Inotropy Index (“INO”)

10. Starling Curves and Inotropy Index (SMII)
+inotropy
Left ventricular end diastolic volume
Stroke
Volume
Index
50
25
SV

11. The Ultimate Diagnostic Device –
The Tricorder

12. OK, so we’re not at the tricorder stage
BUT…
Using the USCOM 1A with SMII and the
BUSH Protocol for the treatment of
septic shock
resulted in…

13. TIME TO HD STABILISATION
BUSH Non-BUSH
1.25 hrs 19.9 hrs
(1.26) (12.9)

14. MORBIDITY
Heart Failure 6.7% 39% 13.7
Respiratory Failure 20% 42.1% 2.92
Renal Failure 8.9% 73.4% 28.6
Tertiary Transfer 4.4% 25% 7.14
BUSH non - OR
BUSH

15. MORTALITY
BUSH Non-BUSH OR
6.7% 38% 13.7
(3/42) (24/63)
NNT = 3.2

16. What next?
We have to do something
similar in paediatric sepsis!!!
We need people to joın us ın
a multı-centre RCT...

17. But it’s too
hard to
learn the
USCOM!

18. Its haemodynamics
Jim,
but not as we know
it!
This
USCOM is
astonishing,
Bones!!

19. Echocardiography is for a few expert users
USCOM is for everybody –
Learn it in a week,
use it for life!!