Abstract
Critically ill patients require close hemodynamic monitoring to titrate treatment on a regular basis. It allows administering fluid with parsimony and adjusting inotropes and vasoactive drugs when necessary. Although invasive monitoring is considered as the reference method, non-invasive monitoring presents the obvious advantage of being associated with fewer complications, at the expanse of accuracy, precision, and step-response change. A great many methods and devices are now used over the world, and this article focuses on several of them, providing with a brief review of related underlying physical principles and validation articles analysis. Reviewed methods include electrical bioimpedance and bioreactance, respiratory-derived cardiac output (CO) monitoring technique, pulse wave transit time, ultrasound CO monitoring, multimodal algorithmic estimation, and inductance thoracocardiography. Quality criteria with which devices were reviewed included: accuracy (closeness of agreement between a measurement value and a true value of the measured), precision (closeness of agreement between replicate measurements on the same or similar objects under specified conditions), and step response change (delay between physiological change and its indication). Our conclusion is that the offer of non-invasive monitoring has improved in the past few years, even though further developments are needed to provide clinicians with sufficiently accurate devices for routine use, as alternative to invasive monitoring devices.
Highlights
Hemodynamic instability requires cardiac output (CO) measurement and tracking to assess severity of disorders and to adjust treatments on a continuous basis
Devices are reviewed using three main metrologic criteria required for CO measurement: trueness, precision
Product of aortic blood flow velocity and area of a section of the aorta equals to the CO measured in the aorta
Summary
Hemodynamic instability requires cardiac output (CO) measurement and tracking to assess severity of disorders and to adjust treatments on a continuous basis. Invasive monitoring is widely used but is associated with inherent iatrogenic complications, notably for pulmonary catheters, esophageal probes, or arterial catheters [1,2,3]. Non-invasive methods offer a safer approach even though their metrologic performance remains challenged, in intensive care units (ICUs) [4, 5]. This article aims to review such non-invasive methods of CO monitoring excluding echographic, thermodilution, and pulse contour methods, already described in other sections. Devices are reviewed using three main metrologic criteria required for CO measurement: trueness (systematic error assessed by the closeness of agreement between the average of an infinite number of replicate measurements and the true or reference value), precision
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