QUICK SETUP OF THE
CHEETAH MEDICAL SYSTEM
In five easy steps
Turn On The Cheetah Medical Monitor
Press the power button until the system turns on
DETERMINATION OF FLUID STATUS*
DETERMINATION OF FLUID STATUS*
Access the
PLR Wizard
Access the
Bolus Test Wizard
Conduct a reversible fluid
challenge in order to determine
fluid responsiveness
Conduct a fluid challenge in order
to determine fluid responsiveness
Passive Leg Raise (PLR)
The PLR wizard will display the peak
hemodynamic change from the baseline
over a 3 min time span
CHEETAH NICOM
Menu >> Protocol >> PLR Test
Fluid Bolus and Hemodynamic Response
The Bolus Wizard will report on the peak
hemodynamic change within the chosen
time-frame. Useful also to capture
hemodynamic impact of drug
selection/titration
Menu >> Protocol >> Bolus Test
STARLING SV
Place & Connect Sensors
Baseline:
Semi-Recumbent position
Place sensors on patient’s body and attach
connectors according to their color
Obtain 3 min of monitoring
for average baseline SVI
The CHEETAH Sensors should be positioned around the
heart. The exact location is flexible. See sensor
package for more information
If the last three SVI readings are
stable, the PLR Test can be operated
from the Challenge stage
Start the Bolus/ Drug
Infusion
45°
•Activate the Bolus Test
function of the CHEETAH monitor.
•Administer a 3ml/kg IV
Bolus over 5min1
Challenge: Leg Raise
For optimal results ensure stable
hemodynamics for 2 min prior to
the bolus
Obtain 3 min of monitoring
for SVI peak value
Bolus Test Results
Prewired Sensors
Main Menu Screen
Select ‘New Patient’
30°-45°
Use a wedge cushion for ease of use
and standardization
Interpretation: Fluid Responsive
∆SVI ≥ 10%
Enter Patient Details
Fluid Responsive: SVI & organ perfusion
will likely increase in response to IV
fluids3-4
Input: ID, Age, Height,
Weight and Gender.
Select Finish
A positive test suggests that the patient is on the
ascending limb of the Frank-Starling curve
17.1%
PLR
Not Fluid
Responsive
Fluid
Responsive
A negative test suggests that the patient is
on the flat limb of the Frank-Starling curve
If inserted data is incorrect: select
‘Update Details’and re-enter data
SVI ∆ = 2.0%
Example of a negative PLR Test
indicating no fluid responsiveness
Patient Information
CHEETAH Sensors should be replaced with a new set of sensors after 48 hours
of use. Remember to preform a re-calibration after sensor replacement and
once daily.
A positive test suggests
that the patient is on the
ascending limb of the
Frank-Starling curve1-2
SVI ∆ = 17.1%
Example of a positive Bolus Test indicating
fluid responsiveness
Interpretation: Not Fluid
Responsive ∆SVI < 10%
Not Fluid Responsive: SVI will
remain flat or hardly increase in
response to IV fluids
Confirm data accuracy,
select ‘Run’ then press ‘OK’
to begin test
Interpretation: Fluid
Responsive ∆SVI ≥ 10%
Frank-Starling curve
Interpretation: Not Fluid
Responsive ∆SVI < 10%
Review Data & Start Test
•At the end of the bolus challenge, stop the Bolus Test
•Note the peak change in the Wizard Report
A negative test suggests that
the patient is on the flat limb
of the Frank-Starling curve
SVI ∆ = 2.0%
Example of a negative Bolus Test indicating
no fluid responsiveness
1 Cecconi M, Parsons AK, Rhodes A. What is a fluid challenge? Curr Opin Crit Care. 2011;17(3):290-5
2 Marik P, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Annals of Intensive Care 2011
3 Monnet X, Teboul JL. Passive leg raising. Intensive Care Med 2008; 34:659-63
4 Benomar B, Ouattara A, Estagnasie P, et al. Fluid responsiveness predicted by noninvasive Bioreactance-based passive leg raise test. Intensive Care Med. 2010;36(11):1875-81
Total Peripheral Resistance (TPR)
Mean Arterial Pressure (MAP)
∆ Stroke Volume Index (∆SVI)
Stroke Volume Index (SVI)
Stroke Volume (SV)
Cardiac Index (CI)
Cardiac Output (CO)
parameter
80 x MAP/CI
80 x (MAP)/CO
Directly from the oscillometric profile
∆ SVI of 250ml over 3 to 5 minutes
SV/BSA
CO/HR x 1000
CO/BSA
HR x SV/1000
equation
1970-2390 dynes . sec/cm5/m2
800-1200 dynes . sec/cm5
70-105 mmHg
<10% Unlikely to be fluid responsive
> 10% Likely to be fluid responsive
33-47 ml/m2/beat
60-100 ml/beat
2.5-4.0 l/min/m2
4.0-8.0 l/min
normal range
patient 3
70/40
90
110/70
1.6 l/min/m2
150
70/40
hypovolemic shock
110/70
150
3.0 l/min/m2
normal
values
70/40
90
5.9 l/min/m2
patient 2
septic shock
110/70
150
3.0 l/min/m2
normal
values
bp
90
1.3 l/min/m2
2500
patient 1
cardiogenic shock
hr
3.0 l/min/m2
2270
normal
values
ci
680
SVI ∆ ≥ 10%
2270
SVI ∆ ≥ 10%
3080
SVI ∆ < 10%
2270
response to plr
IV Fluids
tpri
parameter
Total Peripheral Resistance Index (TPRI)
*
IV Fluids, Antibiotics, Pressors
ARDS-monitor impact of PEEP
Oliguric patients
Patients undergoing Continuous
Renal Replacement Therapy (CRRT)
or Hemodynamically unstable
patients undergoing hemodialysis
Guidance for fluid resuscitation in
Septic patients
Diuretics, Nitrates, Cardiac inotropes
6
7
4
5
treatment
Patients with low blood pressure
and suspected shock due to:
• Septic shock
• Cardiogenic shock
• Hypovolemic shock
Patients with shortness of breathdifferentiating between dyspnea
due to acute heart failure vs.
pulmonary disease
*An alternative method to check for fluid responsiveness is a normal saline fluid bolus.
1
2
3
Patients treated with Inotropes
and/or Vasopressors as a drug
titration aid
CHEETAH Sensors should be replaced with a new set of sensors after 48 hours of use. Remember to preform a re-calibration after sensor replacement
and once daily.
R-MRK-26 rev 2
CONTACT US: Cheetah Medical, Inc. 600 SE Maritime Ave Suite 220 Vancouver, WA 98661 USA Toll free: (+1) 866-751-9097 Tel: (+1) 360-828-8685 Fax: (+1)360-718-8154
Email: [email protected] www.cheetahmedical.com
DISCLAIMER: This document and all content in it are for general information purposes only and are not intended to be specific medical advice, medical opinion, diagnosis or treatment
as applied to any particular patient’s condition or situation. Please do not rely on tis document or its content as a substitute for the expertise and professional judgment of a physician,
pharmacist, nurse, or other healthcare professional. ©Cheetah Medical
CHEETAH Sensors should be replaced with a new set of sensors after 48 hours of
use. Remember to preform a re-calibration after sensor replacement and once daily.
Adult Ranges
Case in point: CI, TPRI in context
by CHEETAH MEDICAL
NORMAL HEMODYNAMIC PARAMETERS
CHEETAH MEDICAL DIFFERENTIAL DIAGNOSIS
PATIENT SELECTION TOOL