Use Of Hemodynamic Monitoring Research Articles

Echocardiography-Based Hemodynamic Monitoring Use on Inpatients Listed for Heart Transplantation Under 2018 Allocation Policy in United States

One notable change to the 2018 United Network for Organ Sharing listing criteria was to allow for the use of noninvasive hemodynamic monitoring for inpatients listed as status 3 for heart transplantation. We wanted to explore the feasibility of performing daily focused echocardiograms in place of invasive monitoring in this population. On retrospective chart review of inpatients listed for transplantation at our institution, 8 patients in the invasive monitoring group listed as status 1A (October 2016 to October 2018) and 9 patients in the echocardiographic group listed as status 3 (October 2018 to February 2020) were identified. There were no significant differences between the 2 cohorts in the average measured/estimated right atrial, pulmonary artery systolic, and wedge pressures, although the echo cohort had lower cardiac index (P=.001). There were 2 patients with positive blood cultures treated with Swan exchange in Swan cohort and a total of 14 Swan exchanges. There were no infections in the noninvasive group. We present our experience with the use of noninvasive daily hemodynamic assessment using focused echocardiograms to manage patients undergoing heart transplantation listing as status 3 under the new United Network for Organ Sharing allocation system. This approach appears safe and feasible; however, it requires validation in larger cohorts.

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.

Intraoperative management and hemodynamic monitoring for ma- jor abdominal surgery : a narrative review

Background : Several trials suggest that postoperative outcomes may be improved by the use of hemodynamic monitoring, but a survey by the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA) showed that cardiac output is monitored by only 34% of ASA and ESA respondents and central venous pressure is monitored by 73% of ASA respondents and 84% of ESA respondents. Moreover, 86.5% of ASA respondents and 98.1% of ESA respondents believe that their current hemodynamic management could be improved (1). The interaction of general anesthesia and surgical stress is the main problem and the leading cause for postoperative morbidity and mortality. The choice of a suitable hemodynamic monitoring system for patients at high anesthesiological risk is of crucial importance to reduce the incidence of major postoperative complications. The aim of the present review is to summarize the benefits of a defined path beginning before surgery, and discuss the available evidence supporting the efficacy and safety of an individualized hemodynamic approach for major abdominal surgery. Objective : To evaluate the clinical effectiveness of a perioperative hemodynamic therapy algorithm in high risk patients

Multi-Channel Facial Photoplethysmography Sensing.

Motivated by the need for continuous cardiovascular monitoring, we present a system for performing photoplethysmography sensing at multiple facial locations. As a proof-of-concept, our system incorporates an optical sensor array into a wearable face mask form factor for application in a surgical hemodynamic monitoring use case. Here we demonstrate that our design can accurately detect pulse timing by validating estimated heart rate against ground truth electrocardiogram recordings. In an experiment across 10 experimental subjects, our system achieves an error standard deviation of 2.84 beats per minute. This system shows promise for performing non-invasive, continuous pulse waveform recording from multiple locations on the face.

Fluid management of the neurological patient: a concise review.

Maintenance fluids in critically ill brain-injured patients are part of routine critical care. Both the amounts of fluid volumes infused and the type and tonicity of maintenance fluids are relevant in understanding the impact of fluids on the pathophysiology of secondary brain injuries in these patients. In this narrative review, current evidence on routine fluid management of critically ill brain-injured patients and use of haemodynamic monitoring is summarized. Pertinent guidelines and consensus statements on fluid management for brain-injured patients are highlighted. In general, existing guidelines indicate that fluid management in these neurocritical care patients should be targeted at euvolemia using isotonic fluids. A critical appraisal is made of the available literature regarding the appropriate amount of fluids, haemodynamic monitoring and which types of fluids should be administered or avoided and a practical approach to fluid management is elaborated. Although hypovolemia is bound to contribute to secondary brain injury, some more recent data have emerged indicating the potential risks of fluid overload. However, it is acknowledged that many factors govern the relationship between fluid management and cerebral blood flow and oxygenation and more research seems warranted to optimise fluid management and improve outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1309-2) contains supplementary material, which is available to authorized users.

Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease.

The purpose of this review is to discuss the management of the low cardiac output syndrome (LCOS) following surgery for congenital heart disease. The LCOS is a well-recognized, frequent post-operative complication with an accepted collection of hemodynamic and physiologic aberrations. Approximately 25% of children experience a decrease in cardiac index of less than 2 L/min/m2 within 6-18 hours after cardiac surgery. Post-operative strategies that may be used to manage patients as risk for or in a state of low cardiac output include the use of hemodynamic monitoring, enabling a timely and accurate assessment of cardiovascular function and tissue oxygenation; optimization of ventricular loading conditions; the judicious use of inotropic agents; an appreciation of and the utilization of positive pressure ventilation for circulatory support; and, in some circumstances, mechanical circulatory support. All interventions and strategies should culminate in improving the relationship between oxygen supply and demand, ensuring adequate tissue oxygenation.

Peripheral venous pressure as a reliable predictor for monitoring central venous pressure in patients with burns.

Sir, The article by Sherif et al.[1] on peripheral venous pressure (PVP) was very interesting. Fluid resuscitation of burns patient is extremely important part of initial management. Peripheral access for fluid resuscitation must be used as it helps in faster initiation of fluid therapy. The use of PVP to monitor hemodynamics and volume status is very innovative. The volume of fluid infusion is calculated as per the formulae based on percentage body surface area affected by burns. The use of hemodynamic monitoring has not been proven to be of much importance in the management of such patients. Most of the studies quoted in this study that have shown any use of invasive monitoring have used pulmonary artery catheter. The benefit of both central venous pressure (CVP) and pulmonary capillary wedge pressure for hemodynamic monitoring have been questioned in various trials and meta-analyses.[2,3] We doubt if there can be a worthwhile role of PVP to help in volume resuscitation of burn patients. The use of central venous access is also important in the hemodynamically unstable patient because it helps to give vasopressor medications, which cannot be given by the peripheral route. These patients may also need mechanical ventilation, which mandates the use of sedative and analgesic medication. Thus in such patients requiring multiple infusions central venous access would be necessary as peripheral access would not be satisfactory in such cases. The Bland-Altman analysis has shown in the study a difference of −1.2 with an standard deviation of +1.96, which means that PVP and CVP can differ by a range of 5.12 mm Hg more to 2.72 mm Hg less.[4] This is not a clinically acceptable margin of error for the use of PVP as a surrogate for CVP. The interpretation of data is thus always a clinical judgment. These findings are similar to the Tugrul et al.[5] study that showed a good correlation but poor clinical agreement. We feel the range is too wide for effective utilization at the bedside. The [Figure 2] is written to be depicting the hourly mean difference between CVP and PVP but in the graph there is no hour axis. We think it's the scatter diagram of the data which has been wrongly labeled. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Monitorização hemodinâmica no paciente crítico

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.

Evidence on the utility of hemodynamic monitorization in the critical patient

Hemodynamic monitoring is a tool of great value for the assessment of critically ill patients. It can not only detect and determine the source of hemodynamic instability, but also guide the choice of appropriate treatment and further evaluate its effectiveness. However, monitoring per se is not a therapeutic tool and its use in the absence of a well-defined objective, need not affect patient outcome. To improve outcome, hemodynamic monitoring necessarily must be coupled to a treatment protocol that has effectively been shown to improve outcome. Accordingly, the usefulness of monitoring systems should be evaluated not only on the basis of the accuracy and reliability of their measurements, but also on the ability to positively affect patient outcome. In this regard, many of the arguments against the use of hemodynamic monitoring are a consequence of non-protocolized use and of application not directed toward specific hemodynamic objectives of proven benefit for the patient.

Evidencia de la utilidad de la monitorización hemodinámica en el paciente crítico

Hemodynamic monitoring is a tool of great value for the assessment of critically ill patients. It can not only detect and determine the source of hemodynamic instability, but also guide the choice of appropriate treatment and further evaluate its effectiveness. However, monitoring per se is not a therapeutic tool and its use in the absence of a well-defined objective, need not affect patient outcome. To improve outcome, hemodynamic monitoring necessarily must be coupled to a treatment protocol that has effectively been shown to improve outcome. Accordingly, the usefulness of monitoring systems should be evaluated not only on the basis of the accuracy and reliability of their measurements, but also on the ability to positively affect patient outcome. In this regard, many of the arguments against the use of hemodynamic monitoring are a consequence of non-protocolized use and of application not directed towards specific hemodynamic objectives of proven benefit for the patient.

Reproducibility of systemic hemodynamics in stable chronic hemodialysis: a pilot study

Hemodynamic measurements are important in the understanding of hemodialysis (HD) hypertension and intradialytic hypotension. The reproducibility of hemodynamic measurements in HD patients is not known and is the objective of this report. We enrolled 13 male patients (mean age 63+/-13 years) on stable chronic HD. Blood pressure (BP) and hemodynamic variables were obtained with a pulse dynamic technology device. Measurements were taken before and after HD, in the supine and standing positions over a 2-week period. Ranges for the average intraindividual standard deviation for each hemodynamic variable before and after HD in both supine and standing positions were: 8.3-14.5 mmHg for oscillometric systolic BP; 4.1-10.7 mmHg for oscillometric diastolic BP; 10.7-14.5 mmHg for manual systolic BP; 5.4-8.8 mmHg for manual diastolic BP; 131.4-188.9 mmHg/s for left ventricular dP/dtmax; 0.17-0.27 L/min/m for cardiac index; 142.4-222.6 dynes/s/cm for systemic vascular resistance; 0.59-1.13%/mmHg for brachial artery distensibility; and 0.09-0.15 ml/mmHg for systemic vascular compliance. Repeated measures analysis of variance results showed no significant variability in measures. Intraclass correlation coefficient ranges were 0.58-0.72 for oscillometric systolic BP, 0.46-0.83 for oscillometric diastolic BP, 0.41-0.62 for manual systolic BP, 0.57-0.84 for manual diastolic BP, 0.10-0.78 for left ventricular dP/dtmax, 0.63-0.84 for cardiac index, 0.47-0.80 for systemic vascular resistance, 0.40-0.84 for brachial artery distensibility, and 0.62-0.88 for systemic vascular compliance. No correlation was observed between interdialytic weight gain and hemodynamic variability. In this pilot study, hemodynamic variables have acceptable reproducibility in chronic stable HD patients. Our results are relevant to the use of hemodynamic monitoring in HD practice and research.

Acute heart failure: Emerging from the shadows

As we emerge from the tremendous progress of the last century, we can take genuine pride in the advances of modern treatments in reducing the morbidity and mortality of cardiovascular diseases, such as hypertension, myocardial infarction, and chronic heart failure. Unfortunately, acute heart failure (AHF) remained largely ignored during this period of discovery, with little research into its epidemiology, pathophysiology, diagnosis, or treatment. However, recent recognition of the significance of AHF has led to investigations that have provided important insights into this syndrome (1), guidelines for its treatment and diagnosis (2, 3), and novel therapies (4), as well as new chapters in leading cardiology textbooks (5). This supplement to Critical Care Medicine is intended to report on the current state of the art as presented by leaders in this rapidly evolving field. Acute heart failure can be defined as the rapid or gradual onset of signs and symptoms of heart failure that result in an urgent, unplanned need for medical care. This heterogeneous syndrome is the primary diagnosis in 1 million hospitalizations in the United States alone, constituting a 174% increase from 1979 to 2003. Drawing on contemporary studies and providing the context for further discourse, Drs. Dar and Cowie (6) present a survey of the epidemiology of AHF, revealing that AHF patients are typically elderly with a history of heart failure, coronary artery disease, and multiple other comorbidities. Our understanding of the pathogenesis of AHF has relied heavily on our models of chronic heart failure, which initially focused on hemodynamic derangements. It is becoming clear, however, that other important mechanisms may be operative in the development of AHF, such as cytokine activation, as described by Dr. Chen and colleagues (7). The potential role of inflammation and immune activation in myocardial dysfunction and damage in the setting of AHF not only may explain the increased morbidity and mortality observed in these patients but also may provide a rationale for future therapeutic targets. The diagnosis of AHF has dramatically improved in the last decade with the advent of new diagnostic modalities. Perhaps the most significant of these tests have been the assays for natriuretic peptides, B-type natriuretic peptide (BNP), and its precursor (NT-proBNP). Dr. Omland (8) discusses these new assays and their practical use in the clinical environment as well as their contributions to estimating clinical course and prognosis. Cardiac imaging technologies have also rapidly improved, and echocardiography is an essential tool in the diagnosis and management of patients with AHF. Dr. Ferrari (9) discusses the role of echocardiography and the exciting new techniques of cardiac computed tomography and magnetic resonance imaging in the management of patients with heart failure. Recent trials have provided new perspectives on the use of hemodynamic monitoring in patients with AHF. Dr. Cotter and associates (10) present the current data regarding invasive hemodynamic monitoring, provide guidance for the use of this important tool, and discuss new noninvasive measurement techniques. As noted previously, AHF is a heterogeneous syndrome, and defining the sub

How is Norepinephrine Used in Intensive Care? A Field Study

ObjectiveTo assess how norepinephrine (NE), an emergency treatment of cardiovascular collapse, is used in intensive care. MethodsNurses and physicians of 14 intensive care units of the Bordeaux University Hospital were given questionnaires on the way they say they use NE and on actual NE treatment of patients. ResultsThe clinical monitoring parameters cited were blood pressure, heart rate and hourly urine flow. Only 25% of the prescribers indicated the systematic use of hemodynamic monitoring. All the prescribers indicated they adapted the treatment to clinical objectives and blood pressure, and 77.5% to hourly urine flow. Initial NE concentrations ranged from 0.5 to 2mg/ml, diluted in saline or dextrose. Initial prescribed dose ranged from 0.1 to 1μg/kg/min. Large differences were observed between services and even within units. ConclusionThese data clearly show the need for recommendations regarding the use of norepinephrine.

Hemodynamic Monitoring in the Care of the Critically Ill Neuroscience Patient

Hemodynamic monitoring in the care of the critically ill neuroscience patient provides information that assists the clinician in minimizing secondary neuronal injury. Whereas no technology replaces the critical care nurse's physical assessment, hemodynamic and neurological monitoring provides additional data beyond what is possible with the clinical examination alone. If neurological technology, such as intracranial pressure monitoring, is not available, hemodynamic monitoring along with the neurological examination provides limited but useful information essential to minimizing secondary neuronal injury. The use of hemodynamic monitoring in critically ill neuroscience patients is best exemplified in the management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Although improved outcomes have not been scientifically substantiated, multimodality monitoring of intracranial dynamics and systemic hemodynamics and manipulation of these parameters during hypertensive hypervolemic hemodilution therapy may lessen the incidence of cerebral infarction secondary to vasospasm. Monitoring systemic hemodynamics and intracranial dynamics simultaneously assists in prevention, prompt recognition, and effective treatment of neurological deterioration.

Routine noninvasive hemodynamic monitoring in acute myocardial infarction: application possibilities

Use of hemodynamic monitoring allows one to evaluate and follow-up patients with acute myocardial infarction (AMI), monitor the effect of treatment, and compare different treatment options. On the other hand this creates additional problems, such as how to choose the method for monitoring that should be cheap, reliable and easy to use for the staff.

Surgical Treatment of Complications of Acute Myocardial Infarction

Complications of acute myocardial infarction that develop within the first 2 weeks after its onset have been associated with a poor prognosis and dismal surgical outcome. In recent years, aggressive use of hemodynamic monitoring and interventions that improve myocardial oxygen supply and demand have noticeably altered the prognosis. Urgent relief of myocardial ischemia with coronary reperfusion has had the largest impact in improving the results. Surgical treatment of mechanical and nonmechanical complications of acute myocardial infarction requires prompt decision making and expeditious implementation. Persistent left ventricular dysfunction and cardiogenic shock are the most important factors that influence the overall results.

Epidemic Bloodstream Infections from Hemodynamic Pressure Monitoring: Signs of the Times

Arterial pressure monitoring is an essential feature of the care of approximately 80% of the millions of patients cared for in hospital intensive care units in this country each year.',2 Despite numerous reports of epidemic bloodstream infection traced to pressure monitoring3-21 and published guidelines for safe use of hemodynamic monitoring,22,23 outbreaks of nosocomial bacteremia have continued to plague unwary users of this special application of infusion therapy. In this issue of Infection Control and Hospital Epidemiology (pp 54-59), Beck-Sague and Jarvis report eight outbreaks of nosocomial bloodstream infection traced to contamination of transducers used for

Epidemic bloodstream infections from hemodynamic pressure monitoring: signs of the times.

Arterial pressure monitoring is an essential feature of the care of approximately 80% of the millions of patients cared for in hospital intensive care units in this country each year.',2 Despite numerous reports of epidemic bloodstream infection traced to pressure monitoring3-21 and published guidelines for safe use of hemodynamic monitoring,22,23 outbreaks of nosocomial bacteremia have continued to plague unwary users of this special application of infusion therapy. In this issue of Infection Control and Hospital Epidemiology (pp 54-59), Beck-Sague and Jarvis report eight outbreaks of nosocomial bloodstream infection traced to contamination of transducers used for

Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts).

In the broadest sense, current hospital therapy of acute myocardial infarction attempts to prevent, or promptly and effectively treat, the electrical and mechanical consequences of regional myocardial ischemia or infarction, while preserving jeopardized ischemic myocardium. Prevention and effective therapy of arrhythmias have largely been realized through the development of coronary-care units. The goals of prompt and effective therapy of disordered cardiac function and preservation of ischemic muscle, although far from achieved, have been greatly advanced in the past several years by the widespread use of hemodynamic monitoring. As a result, new concepts concerning the disease itself and new therapies have . . .