Functional Hemodynamic Monitoring: Foundations and Future

Abstract

Hemodynamic monitoring is one of the major diagnostic tools available in the acute care setting to diagnose cardiovascular insufficiency and monitor changes over time in response to interventions. However, in recent years, the rationale and efficacy of hemodynamic monitoring to affect outcome has come into question. We now have increasing evidence that outcome from critical illness can be improved by focused resuscitation based on existing hemodynamic monitoring, whereas non-specific aggressive resuscitation impairs survival. Thus, the stage is set to frame hemodynamic monitoring into a functional perspective wherein hemodynamic variables and physiology interact to derive performance and physiological reserve estimates that drive treatment. Any discussion on the utility of hemodynamic monitoring must start from the perspective of one scientific truth that is often forgotten when discussing the efficacy of new diagnostic tests or monitoring devices. Namely, that no monitoring device, no matter how simple or sophisticated, will improve patient-centered outcomes useless coupled to a treatment which, itself, improves outcome. Thus, hemodynamic monitoring needs to be considered within the context of clinical condition, pathophysiological state, and sites within the acute care delivery system wherein this monitoring takes place.