Paradigm Shift in Hemodynamic Monitoring

Abstract

Since the beginning of modern anesthesia, in 1846, the anesthesiologist has relied on his natural senses like finger on the pulse to monitor the patient, aided recently by sophisticated instruments like stethoscope, sphygmomanometer, ECG etc. The first paradigm shift in hemodynamic monitoring can be traced back to the development of cardiac catheterization by Werner Forssmann in 1929 and subsequent introduction of pulmonary artery catheterization and thermodilution techniques, in 1970, by Swan, Ganz and colleagues. For more than three decades pulmonary artery catheter thermodilution method has generally been accepted and is still the clinical standard to which other methods are compared. The long history of use has led to much experience with its technology, clinical application and inadequacies. Recent advances in technology have led to the development of minimally invasive and non-invasive methods. The development of impedance cardiography and advances in electronics and signal processing has led to the development of completely non-invasive monitors which can provide continuous measurement of hemodynamic parameters and can be considered as the recent paradigm shift in critical care monitoring. The present article deals with the various invasive, minimally invasive and non-invasive techniques currently in use and their physiological basis.