Crit care question

[joyous17]

I have this case study that I'm trying to figure out but based on the patient's presentation and intervention provided, the current assessment findings don't really make sense...

This is a patient who had 20% burns to the face and upper body. He's also intubated and ventilated and a bronchoscopy revealed inhalation trauma. He's on SIMV 12, FiO2 0.65, pressure control is 25cmH20 and PEEP is 10cmH20.

He was given 18L of crystalloids over the first 24 hours, allowing sufficient diuresis. Fluid resus continued over the next 5 days to maintain haemodynamic stability. However, on day 5 the patient became haemodynamically unstable and there was a deterioration in gas exchange.

His haemodynamic findings are now:

HR - 130bpm (high)

MAP - 54 (low)

Cardiac index - 7.9 (high)

Global end-diastolic volume index - 680 (within normal range but on the lower side)

SVR - 560 (low)

Extravascular lung water index - 13 (high --> pulmonary oedema)

So I understand that the patient is most likely fluid overloaded and now has pulmonary oedema and because of this third spacing, I understood that the patient would have a low MAP because of decreased intravascular volume and therefore becomes tachycardic as a compensatory mechanism. However, what I don't really understand is why the patient has a high cardiac index if there is decreased circulatory volume and the patient's MAP is low.

Does anyone know why the patient would have a high cardiac index esp. considering he has a low SVR??

[/username, BSN, RN]

The low SVR is precisely why they have a high CI.......... There's no resistance for the heart to pump against, so it's able to pump much more blood than normal, especially if they're that tachy.

They need lasix and a pressor. Pressor first.

[joyous17]

*facepalms* hahahaha ohhh yeah i get it LOL sorry that was a stupid question but thanks for your help :)