System for therapeutic management of hemodynamic state of patient
First Claim
1. A method of achieving a preselected hemodynamic state in a subject mammal comprising the steps of:
- (a) determining the subject'"'"'s mean arterial pressure (MAP);
(b) measuring the subject'"'"'s cardiac index (CI);
(C) determining the subject'"'"'s left cardiac work index (LCWI) utilizing the measured MAP and CI values according to the formula;
space="preserve" listing-type="equation">LCWI=(MAP-PAOP)×
CI×
Kwherein PAOP represents pulmonary artery occluded pressure and K is a constant;
(D) determining the subject'"'"'s systemic vascular resistance index utilizing the measured MAP and CI values according to the formula;
##EQU7## wherein SVRI represents the systemic vascular resistance index, CVP is central venous pressure and L is a constant;
(E) preselecting a desired hemodynamic state, defined by desired values for LCWI and SVRI;
(F) determining the percentage deviation of the subject'"'"'s determined values for LCWI above or below the desired value for LCWI;
(G) determining the percentage deviation of the subject'"'"'s determined values for SVRI above or below the desired value for SVRI;
(H) administering a therapeutic doses of pharmacologically active materials for altering the LCWI and SVRI values to achieve in the subject the preselected hemodynamic state.
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Accused Products
Abstract
A therapeutic system provides a clinician with an appropriate course of treatment for a patient whose cardiovascular system is operating outside the normal range of values for the left cardiac work index (LCWI) and the systemic vascular resistance index (SVRI). The left cardiac work index and the systemic vascular resistance index are calculated from the cardiac index (CI) and mean arterial blood pressure (MAP) and are displayed as relative values so that the clinician can readily determine which of the vascular parameters are outside the normal range. Preferably, the cardiac index and the other cardiac parameters are measured by an electrical bioimpedance monitor that provides continuous dynamic measurement of the parameters. The left cardiac work index and the systemic vascular resistance index are calculated by a personal computer that displays the calculated parameters in an easily discernible manner.
124 Citations
38 Claims
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1. A method of achieving a preselected hemodynamic state in a subject mammal comprising the steps of:
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(a) determining the subject'"'"'s mean arterial pressure (MAP); (b) measuring the subject'"'"'s cardiac index (CI); (C) determining the subject'"'"'s left cardiac work index (LCWI) utilizing the measured MAP and CI values according to the formula;
space="preserve" listing-type="equation">LCWI=(MAP-PAOP)×
CI×
Kwherein PAOP represents pulmonary artery occluded pressure and K is a constant; (D) determining the subject'"'"'s systemic vascular resistance index utilizing the measured MAP and CI values according to the formula;
##EQU7## wherein SVRI represents the systemic vascular resistance index, CVP is central venous pressure and L is a constant;(E) preselecting a desired hemodynamic state, defined by desired values for LCWI and SVRI; (F) determining the percentage deviation of the subject'"'"'s determined values for LCWI above or below the desired value for LCWI; (G) determining the percentage deviation of the subject'"'"'s determined values for SVRI above or below the desired value for SVRI; (H) administering a therapeutic doses of pharmacologically active materials for altering the LCWI and SVRI values to achieve in the subject the preselected hemodynamic state. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20)
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21. A method of achieving a preselected hemodynamic state in a mammal, comprising the steps of:
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determining means arterial pressure in the mammal; measuring cardiac index in the mammal; measuring acceleration index in the mammal; determining a first deviation, if any, from a preselected volemic state; determining a second deviation, if any, from a preselected capacitive state; determining a third deviation, if any, from a preselected inotropic state; and administering a therapeutic dose of at least one pharmacologically active material for altering the first, second and third deviations to achieve a preselected hemodynamic state. - View Dependent Claims (22, 23, 24, 25, 26, 27, 28)
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29. A method of determining and correcting deviations from normodynamic circulation, consisting of normovolemia, normovasoactivity and normoinotropy, in a subject mammal, comprising the steps of:
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(a) determining the subject'"'"'s mean arterial pressure (MAP); (b) measuring the subject'"'"'s cardiac index (CI); (c) determining the subject'"'"'s left cardiac work index (LCWI) utilizing the measured MAP and CI values according to the formula;
space="preserve" listing-type="equation">LCWI=(MAP-PAOP)×
CI×
Kwherein PAOP is the pulmonary artery occluded pressure and K is a constant; (d) determining a first deviation from normal LCWI by utilizing the determined value for LCWI according to the formula;
##EQU8## (e) measuring the subject'"'"'s acceleration index (ACI);
(f) determining a second deviation from normoinotropy by utilizing the measured value for ACI according to the formula;
space="preserve" listing-type="equation">deviation=ACI/normal ACI(g) determining a third deviation from normovolemia, comprising subtracting the second deviation from the first deviation; (h) determining the subject'"'"'s systemic vascular resistance index utilizing the measured MAP and CI values according to the formula;
##EQU9## wherein SVRI represents the systemic vascular resistance index, CVP is central venous pressure and L is a constant;(i) determining a fourth deviation from normovasoactivity by utilizing the determined value for SVRI according to the formula;
##EQU10## (j) increasing fluid volume if the third deviation is not substantially zero and the first deviation is less than 1.0, and decreasing fluid volume if the third deviation is not substantially zero and the first deviation is greater than 1.0;(k) causing vasodilation in the subject if the fourth deviation is greater than 1.0, and causing vasorestriction if the fourth deviation is less than 1.0; and (l) causing a negative inotropic effect in the subject if the second deviation is greater than 1.0, and causing a positive inotropic effect in the subject if the second deviation is greater than 1.0. - View Dependent Claims (30, 31, 36, 37, 38)
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32. A method of determining and correcting deviations from normovasoactivity in a subject mammal, comprising the steps of:
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(a) determining the subject'"'"'s mean arterial pressure (MAP); (b) measuring the subject'"'"'s cardiac index (CI); (c) determining the subject'"'"'s systemic vascular resistance index utilizing the measured MAP and CI values according to the formula;
##EQU11## wherein SVRI represents the systemic vascular resistance index, CVP is central venous pressure and L is a constant;(d) determining a deviation from normovasoactivity by utilizing the determined value for SVRI according to the formula;
##EQU12## and;
(e) administering a pharmacologically vasoconstrive material if the deviation is less than one, and administering a pharmacologically vasocilating material if the deviation is greater than one. - View Dependent Claims (33)
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34. A method of determining deviations from normodynamic circulation, consisting of normoinotropy, normovolemia and normovasoactivity in a subject mammal, comprising:
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(a) determining the subject'"'"'s mean arterial pressure (MAP); (b) measuring the subject'"'"'s cardiac index (CI); (c) determining the subject'"'"'s left cardiac work index (LCWI) utilizing the measured MAP and CI values according to the formula;
space="preserve" listing-type="equation">LCWI=(MAP-PAOP)×
CI×
Kwherein PAOP is the pulmonary artery occluded pressure and K is a constant; (d) determining a deviation (1) from normal LCWI by utilizing the determined value for LCWI according to the formula;
##EQU13## (e) measuring the subject'"'"'s acceleration index (ACI);
(f) determining the deviation (2) in inotropy from normoinotropy by utilizing the measured value for ACI according to the formula;
space="preserve" listing-type="equation">deviation (2)=ACI/normal ACI(g) determining the deviation (3) in volemia from normovolemia, comprising subtracting deviation (2) from deviation (1); (h) determining the subject'"'"'s systemic vascular resistance index utilizing the measured MAP and CI values according to the formula;
##EQU14## wherein SVRI represents the systemic vascular resistance index, CVP is central venous pressure and L is a constant; and(i) determining deviation (4) in vasoactivity from normovasoactivity by utilizing the determined value for SVRI according to the formula;
##EQU15##
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35. A method of determining and correcting devaitions from normovolemia in a subject mammal, comprising the steps of:
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(a) determining the subject'"'"'s mean arterial pressure (MAP); (b) measuring the subject'"'"'s cardiac index (CI); (c) determining the subject'"'"'s left cardiac work index (LCWI) utilizing the measured MAP and CI values according to the formula;
space="preserve" listing-type="equation">LCWI=(MAP-PAOP)×
CI×
Kwherein PAOP is the pulmonary artery occulded pressure and K is a constant; (d) determining a first deviation from normal LCWI by utilizing the determined value for LCWI according to the formula;
##EQU16## (e) measuring the subject'"'"'s acceleration index (ACI);
(f) determining a second deviation from normoinotropy by utilizing the measured value for ACI according to the formula;
space="preserve" listing-type="equation">deviation=ACI/normal ACI(g) determining a third deviation from normovolemia, comprising subtracting the second deviation from the first deviation; and (h) increasing fluid volume if the third deviation is zero or negative and the first deviation is less than 1.0, and decreasing fluid volume if the third deviation is zero or positive and the first deviation is greater than 1.0.
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Specification