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Principles of Adult Surgical Critical Care pp 63–76Cite as

Hemodynamic Monitoring and Resuscitation

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Abstract

The patient presenting in shock due to injury, sepsis, or cardiac injury is a common component of critical care practice. During the course of critical illness, patients go through a series of neuroendocrine changes that result in transient alterations in vascular tone, myocardial workload, and fluid distribution. Hemodynamic monitoring is used to identify the cause of shock, to titrate therapy, to assess fluid responsiveness, and to guide “deresuscitation.”

Traditional “static” monitors of volume status, such as central venous pressure and pulmonary capillary wedge pressure, have been discredited. They have been replaced with dynamic monitors that use the aortic waveform to derive stroke volume. From the waveform, pulse pressure variability, systolic pressure variability, and stroke volume variability can be measured and used to detect fluid responsiveness. Rather than administering recurrent boluses of fluid, passive leg raising and end-expiratory occlusion may be used to assess the cardiovascular response to increasing preload.

Finally, focused cardiac ultrasound is emerging as an essential tool to rapidly diagnose the cause of shock and to titrate therapy.

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Authors and Affiliations

  1. Anaesthesia & Intensive Care, Galway University Hospitals, Galway, Ireland

    Patrick J. Neligan MA, MB, FCARCSI, FJFICM

  2. Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Jiri Horak MD

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  1. Patrick J. Neligan MA, MB, FCARCSI, FJFICM
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Correspondence to Patrick J. Neligan MA, MB, FCARCSI, FJFICM .

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Editors and Affiliations

  1. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Niels D. Martin

  2. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Lewis J. Kaplan

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Neligan, P.J., Horak, J. (2016). Hemodynamic Monitoring and Resuscitation. In: Martin, N.D., Kaplan, L.J. (eds) Principles of Adult Surgical Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-33341-0_7

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