Abstract
Hemodynamic monitoring plays a fundamental role in the management of acutely ill patients. With increased concerns about the use of invasive techniques, notably the pulmonary artery catheter, to measure cardiac output, recent years have seen an influx of new, less-invasive means of measuring hemodynamic variables, leaving the clinician somewhat bewildered as to which technique, if any, is best and which he/she should use. In this consensus paper, we try to provide some clarification, offering an objective review of the available monitoring systems, including their specific advantages and limitations, and highlighting some key principles underlying hemodynamic monitoring in critically ill patients.
Highlights
Hemodynamic monitoring plays an important role in the management of today’s acutely ill patient
Most devices have been evaluated by comparing their results with those obtained by intermittent thermodilution from the pulmonary artery catheter (PAC) as the reference, this technique has its own limitations and may not represent the best choice of comparator [2]
Systems that are not continuous or that require calibration may not provide the real-time data needed for optimal acute management of unstable critically ill patients, whereas systems that provide continuous non-calibrated cardiac output measurements suffer from reduced accuracy
Summary
Hemodynamic monitoring plays an important role in the management of today’s acutely ill patient. Hemodynamic monitoring can be helpful in two key settings. The pulmonary artery catheter (PAC) has long been considered the optimal form of hemodynamic monitoring, allowing for the almost continuous, simultaneous recording of pulmonary artery and cardiac filling pressures, cardiac output and SvO2. There are many different monitoring systems available, and physicians may feel somewhat confused by the multiple possibilities. These systems can be listed in order of degree of invasiveness, from the highly invasive PAC to the completely non-invasive bioimpedance/ bioreactance technique and transthoracic echo-Doppler. Most devices have been evaluated by comparing their results with those obtained by intermittent thermodilution from the PAC as the reference, this technique has its own limitations and may not represent the best choice of comparator [2]
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