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Hemodynamics

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Pediatric Critical Care

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Abstract

The cardiovascular system is responsible for providing adequate blood flow delivering nutrients to meet the metabolic demands of the body and its organs. The principles governing blood flow and pressure in the vascular system are referred to as hemodynamics. The most significant function of the cardiovascular system is the delivery of oxygen needed to meet the demand for cellular oxygen consumption. Although increases in oxygen delivery can occur over time through an increase in hemoglobin concentration, during an acute illness, the primary physiologic response to an increase in oxygen demand is an increase in cardiac output. If cardiac output is not sufficient to meet the metabolic needs of the body as a whole, a redistribution of regional blood flow and constriction of venous capacitance vessels must occur to maintain adequate oxygen delivery to vital organs. If the redistribution of blood flow is insufficient to meet the metabolic demands of a specific organ, organ dysfunction will begin to develop. The cardiovascular system of an otherwise healthy child with acute illness will typically perform this redistribution of regional blood flow function well, but in the critically ill child, the physiologic response to increasing oxygen demand may be inadequate resulting in a shock state. Caring for the child with critical illness often requires interventions by the intensivist to balance oxygen and nutrient delivery with oxygen consumption and waste removal. In some cases, therapeutic interventions to support one system, such as positive pressure mechanical ventilation to support breathing, may have undesirable effects on the cardiovascular system. When caring for the critically ill child, it is important to have a fundamental understanding of normal cardiac physiology, cardiopulmonary interactions, and how critical illness and therapeutic interventions can alter cardiac function. This chapter reviews the physiology and function of the heart and how critical illness alters cardiovascular physiology. In addition, the unique interactions that occur between the heart and lungs will be discussed in both the healthy and ill child including the unique cardiopulmonary interactions in a child with single ventricle anatomy.

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Author information

Authors and Affiliations

  1. Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, American Family Children’s Hospital, Madison, WI, USA

    Scott A. Hagen & Awni M. Al-Subu

  2. Pediatric Critical Care Medicine, Department of Pediatrics, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, WI, USA

    Nathan Thompson

  3. Pediatric Special Needs Program/Complex Care Medicine, Department of Pediatrics, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, WI, USA

    Timothy E. Corden

Authors
  1. Scott A. Hagen
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  2. Awni M. Al-Subu
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  3. Nathan Thompson
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  4. Timothy E. Corden
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Corresponding author

Correspondence to Scott A. Hagen .

Editor information

Editors and Affiliations

  1. Penn State Hershey Children’s Hospital, Pediatric Critical Care Medicine, Hershey, PA, USA

    Steven E. Lucking

  2. Division of Pediatric Critical Care, Department of Pediatrics, Janet Weis Children’s Hospital, Geisinger Medical Center, Danville, PA, USA

    Frank A. Maffei

  3. Department of Pediatrics/Divisions of Pediatric Critical and Palliative Care Medicine, Janet Weis Children’s Hospital at Geisinger, Geisinger Commonwealth School of Medicine, Danville, PA, USA

    Robert F. Tamburro

  4. Department of Pediatrics, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk, VA, USA

    Arno Zaritsky

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Hagen, S.A., Al-Subu, A.M., Thompson, N., Corden, T.E. (2021). Hemodynamics. In: Lucking, S.E., Maffei, F.A., Tamburro, R.F., Zaritsky, A. (eds) Pediatric Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-53363-2_14

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  • DOI: https://doi.org/10.1007/978-3-030-53363-2_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-53362-5

  • Online ISBN: 978-3-030-53363-2

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