I have recently transfered to a CCU after doing ER nursing for 3 years. I had a fresh open heart patient the other night. The patient came back with a CO 14.6 and a CI 7.1 with an SVR 246, and a SBP in the 80's..... this was on 3 mcg of dopamine and 8 mcg of EPI. Throughout the night I had the pt up to 10 mcg of EPI, 200 mcg of NEO, 3 mcg of Dopamine, and 0.04 units an hr of Vassopressin....... To get me to an SVR of 496 and an SBP crashing in the 70's. Needless to say we did an emergent IABP at bedside.
Now for my questions.... why couldn't I get an SVR??? My white count actually decreased throughout the night going from 22 to 18, kinda ruling out sepsis. My patient was an emergent CABG so I if anything I would actually expect cardiogenic shock with a high SVR????
Just looking for some ideas from experienced CCU nurses...Thanks!!
Sep 4, '10
Quote from fiveofpeep
why would increasing volume increase your systemic vascular resistance? I can see increased volume increasing preload and thus increasing CO and BP but not SVR.
Very interesting about the vasoplegia. Ive had some bizarre hours of critically low SVR with my limited experience with OHs. I need to be less green before I take the fresh ones, and Ive always chalked it up to infection/sepsis because it happened to be concurrent.
I believe adding volume does increase your SVR. While it doesn't constrict your vessels like you typically think of an increased SVR it does add volume and pressure to those vessels and therefore resistance. But as you mentioned, adding volume may increase the CO driving the SVR equation down and/or increasing the MAP, driving the SVR up.
Just for review: SVR = MAP-CVP/CO x80
Last edit by aCRNAhopeful on Sep 4, '10