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HOTMAN System: Hemodynamic Management Modeling Page

Hemodynamic Management Modeling can only be performed while observing the patient in the Hemodynamic Management Page.
Following is an example of hemodynamic management modeling of a hypertensive patient described in the Monitoring Page (All Noninvasive data) and Hemodynamic Management Page.
The patient's Hemodynamic Management Page is displayed below:

Hemodynamic Management Page of a hypertensive patient:
Heading HEMODYNAMIC STATE: This patient's blood pressure at the time of the measurement was 192/101, resulting in MAP = 131 Torr = mmHg (a 53% hypertension). The patient has both systolic and diastolic hypertension. SI = 24 ml/m2 (98% hypodynamic state). As you can see under the heading HEMODYNAMIC MODULATORS, the causes of this patients hypertension were (a) 25% hypervolemia, (b) 51% hypoinotropy (ISI = 0.63 1/sec2), and (c) 209% vasoconstriction. The Perfusion blood flow was identified as 58% hypochronotropy.

By pressing the "E" key (while in the Hemodynamic Management Page), the panel with analog traces is replaced by 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:

Hemodynamic Modeling Page of a hypertensive patient: The 25% hypervolemia vas corrected by sliding the VOLUME slider toward Volume Reduction (diuresis) until "NORMOVOLEMIA" was displayed under HEMODYNAMIC MODULATORS. Similarly, the Inotropy slider was moved toward Positive Inotropes, until "NORMOINOTROPY" was displayed. The 209% vasoconstriction was corrected by sliding the Vasoctive drugs slider towards Vasodilators/ACEI/ARB. Since the hemodynamic modulation increased the SI value up to its normal level, the patient became "normochronotropic" and no action in respect to chronotropy was needed. As a result of rendering the patient normochronotropic, normovolemic, normoinotropic and normovasoactive, his hemodynamic state became normotension @ normodynamic.
 

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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