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HOTMAN® BAS System: Hemodynamic Management Modeling Screen

Hemodynamic Management Modeling ("E") can only be performed while in the Hemodynamic Management ("G") Page.
Following is an example of hemodynamic management modeling of a hypertensive patient.
The patient's Hemodynamic Management Page is displayed below:

G

Hemodynamic Management Page of a hypertensive patient: This patient's blood pressure at the time of the measurement was 183/110, resulting in MAP = 134 Torr (a 58% hypertension). The Stroke Index was SI = 43 ml/mSuperscript2 (a normodynamic state), while ISI = 1.26 1/secSuperscript2 (a normoinotropy). As you can see under the heading HEMODYNAMIC MODULATORS, the causes of this patients hypertension were (a) 25% hyperchronotropy, (b) 51% hypervolemia and (c) 77% vasoconstriction.

By pressing the "E" key (while in the Hemodynamic Management Page), the panel with analog traces is replaced with the hemodynamic management modeling panel, where the operator can adjust the level of three hemodynamic modulators (volume, inotropy and vasoactivity) and one perfusion blood flow modulator (chronotropy) using the mouse to move the corresponding sliders as to correct the listed deviations in the modulators. The yellow dot represents the original hemodynamic state of the patient, the red dot represents the predicted hemodynamic state after application of therapies correcting the above-listed deviations in hemodynamic modulators. The predicted hemodynamic state is a a vectorial sum of individual therapies:

ModelG

Hemodynamic Management Modeling of a hypertensive patient displayed at the top of the page. The 51% hypervolemia vas corrected by sliding the VOLUME slider toward Volume Reduction (diuresis). Since the patient was normoinotropic, the INOTROPES slider was left at its original, center position. The 77% vasoconstriction was corrected by sliding the VASOACTIVE DRUGS slider towards Vasodilators/ACE Inhibitors. Subsequently, the hyperchronotropy was corrected by sliding the CHRONOTROPES slider towards Negative Chronotropes. As a result of rendering the patient normochronotropic, normovolemic, normoinotropic and normovasoactive, her hemodynamic state will be normotension @ normodynamic state.

This modeling example shows the fallacy of current treatment of hemodynamic disorders by trial-and-error or by a dogmatic application of step therapy or other therapies designed to treat the cause (i.e., the hypertension) and not striving to identify the causes and to correct them therapeutically.

A general rule for selection of dosage of a cardioactive and/or vasoactive drug is:
For displayed deviations 20-40% use a low dosage of available drug, for deviations 40-60%, use a medium dosage of available drug, and for deviations >60% use a high dose of available drug.


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