Monitorização hemodinâmica no paciente crítico

Abstract

Hemodynamic monitoring has crucial role in critically ill patients, especially if associated with a known therapy that improves the prognosis of these patients. The reduction in the use of pulmonary artery catheter, due to its low impact on mortality, enabled the emergence of new forms of less invasive measurement of cardiac output as data based on analysis of the pulse contour, esophageal Doppler, transthoracic echocardiography, electrical Bioimpedance and Bioreactance. The monitors based on pulse wave can use the calibration by thermodilution, by dilution dye (lithium) or using a preset algorithm for data calibration. Despite been increasingly used, it’s utilization in unstable critically ill patients is a matter of debate. The use of esophageal Doppler monitoring also permits a minimally invasive monitoring, despite the need for frequent adjustments in positioning in addition to continuous analgesia and sedation. The use of transthoracic echocardiography in the management of critically ill patients is gaining ground, despite requiring specific training and proper equipment despite of not allowing continuous recording data. The use of electrical Bioimpedance or Bioreactance has little use in unstable ill patients. The use of hemodynamic monitoring associated with dynamic variable scan predict which patients will possibly benefit from intravascular volume expansion therapy, a finding highly relevant in handling the hypotensive patient in the ICU. Finally, it is important to emphasize that the choice of a particular type of monitoring should respect the severity of the critically ill patient, the degree of experience of the institution with certain equipment and must be associated with goal-directed therapies in patients with hemodynamic instability.