Hemodynamic Monitoring in Surgical Critical Care
Hemodynamic monitoring has been an essential element of medical care and arguably the corner stone of patient care delivery in any acute clinical setting. However, despite medicine’s modern evolution and technological advancements, hemodynamic monitoring continues to be a much debated topic with polarized differences of opinion. The debate has existed, and continues to exist, due in part to the historic difficulty that researchers and clinicians have had in identifying a universally acceptable modality to obtain accurate and reproducible data regarding cardiovascular performance, responsiveness to therapeutic interventions, appropriate end points of resuscitation, or therapeutic efforts.
Methods of hemodynamic assessment include indirect and direct perfusion (pressure and flow) measurements and the more recently acknowledged, direct visualization methods. While all modalities have advantages, disadvantages, and some degree of imprecision, no single technique is inadequate or useless nor has any one modality proven to be a stand-alone solution to complex resuscitation scenarios. While research is unceasing in establishing a gold standard for hemodynamic monitoring and an accompanied end point of resuscitation, a thorough understanding of existing and evolving hemodynamic monitoring strategies and concepts is a necessary prerequisite for the practicing intensivist.
KeywordsEchocardiography Central venous pressure Arterial pressure Peripheral perfusion Venous oxygen saturation
- 1.Marino PL. The ICU book. Philadelphia: Lippincott Williams and Wilkins; 2007.Google Scholar
- 2.Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals, part 1: blood pressure measurements in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the AHA Council on HBP. Circulation. 2005;111:697–716.CrossRefGoogle Scholar
- 8.Wilson WC, Grande CM, Hoyt DB. Trauma: critical care. New York: Informa Healthcare USA, Inc.; 2007.Google Scholar
- 16.Miami Trauma Clinical Trials Group. Splanchnic hypoperfusion-directed therapies in trauma: a prospective randomized trial. Am Surg. 2005;71(3):252–60.Google Scholar
- 32.Sasse SE, Chen PA, Berry RB, et al. Variability of cardiac output over time in medical intensive care unit patients. Chest. 1994;22:225–32.Google Scholar
- 36.Noll ML, Fountain RL, Duncan CA, et al. Fluctuations in mixed venous oxygen saturation in critically ill medical patients: a pilot study. Am J Crit Care. 1992;3:102–6.Google Scholar
- 40.Hales S. Statiskal essays: vegetable staticks, I(3):361. In: Innys W, Manby R, editors. London; 1738. Cited in Geddas LA. The direct and indirect measurement of blood pressure. Chicago: Yearbook Medical Publishers; 1970.Google Scholar
- 42.Ladoto RF. Arterial pressure monitoring. In: Tobin MJ, editor. Principles and practice of intensive care monitoring. New York: McGraw-Hill Companies; 1998. p. 733–49.Google Scholar
- 44.Mangaon DT, Hickey RF. Ischemic injury following uncomplicated radial artery catheterization. Anesth Analg. 1979;58:55–7.Google Scholar
Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (http://creativecommons.org/licenses/by-nc/2.5/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.