Forester Hemodynamic Subsets and Therapy_1

Forester Hemodynamic Subsets and Therapy_1

1. Subset I

   • Normal
     • Warm and Dry
       • Optimize Oral medications
       • PCWP 15-18 and CI >2.2

2. Subset II

   • Congestion
     • Warm and Wet
       • Pulmonary/Peripheral Congestion
         • PCWP >18 AND CI >2.2
           • IV diuretics
             • IV vasodilators

3. Subset III

   • Hypoperfused
     • Cold and Dry
       • PCWP 15-18 and CI>2.2
         • IF PCWP <15 --IVF until 15-18
           • IF PCWP >/=15 & MAP <50 ---iv DOPAMINE
             • IF PCWP>/=15 & MAP >/=50
               • Compelling Reason--INOTROPE
               • NO Compelling reason--IV Vasodilator (arterial)

4. Subset IV

   • Congestion and Hypoperfusion
     • Cold and Wet
       • PCWP >18 & CI <2.2
         • IV diuretics AND
           • IF MAP <50--IV Dopamine
             • if MAP >/=50
               • NO compelling reason--IV Vasodilator
               • Compelling Reason--Inotrope
       • Pulmonary/Peripheral Congestion & Hypoperfusion

5. CI 2.2

6. PCWP 18