Advertisement

Cardiovascular Assessment

  • Irene Comisso
  • Alberto Lucchini
Chapter

Abstract

Cardiovascular monitoring allows the assessment of cardiac function and tissue perfusion. During the last century, cardiovascular monitoring reached very important progresses, concerning the measurement of blood pressures and the evaluation of the electrical activity. Oxygen demand and consumption has also become an important component of cardiovascular assessment, and further evolutions during the past decades allowed the measurement of blood flow and blood volume. Such improvements guide clinicians in choosing the best strategies in cardiac dysfunction and help targeting the fluid and drug therapy.

Keywords

Cardiovascular monitoring Blood pressures Oxygen delivery and consumption Cardiac output Venous oxygen saturation Volemia measurement 

References

  1. 1.
    Thompson JP, Mahajan RP. Monitoring the monitors—beyond risk management. Br J Anaesth. 2006;97:1–3.  https://doi.org/10.1093/bja/ael139.CrossRefPubMedGoogle Scholar
  2. 2.
    Hofer CK, Cecconi M, Marx G, della Rocca G. Minimally invasive haemodynamic monitoring. Eur J Anaesthesiol. 2009;26:996–1002.CrossRefPubMedGoogle Scholar
  3. 3.
    JCGM 200:2008. International vocabulary of metrology—basic and general concepts and associated terms (VIM). http://www.bipm.org/utils/common/documents/jcgm/JCGM_200_2008.pdf. Accessed 30 Jul 2017.
  4. 4.
    Hannibal GB. It started with Einthoven: the history of the ECG and cardiac monitoring. AACN Adv Crit Care. 2011;22:93–6.  https://doi.org/10.1097/10.1097/NCI.0b013e3181fffe4c.CrossRefPubMedGoogle Scholar
  5. 5.
    Petty BG. Basic electrocardiography. New York: Springer; 2015.  https://doi.org/10.1007/978-1-4939-2413-4.CrossRefGoogle Scholar
  6. 6.
    Drew BJ, Califf RM, Funk M, et al. Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation. 2004;110:2721–46.  https://doi.org/10.1161/01.CIR.0000145144.56673.59.CrossRefPubMedGoogle Scholar
  7. 7.
    Baranchuk A, Shaw C, Alanazi H, Campbell D, Bally K, Redfearn DP, et al. Electrocardiography pitfalls and artifacts: the 10 commandments. Crit Care Nurse. 2009;29:67–73.  https://doi.org/10.4037/ccn2009607.CrossRefPubMedGoogle Scholar
  8. 8.
    Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970;283:447–51.  https://doi.org/10.1056/NEJM197008272830902.CrossRefPubMedGoogle Scholar
  9. 9.
    Moise SF, Sinclair CJ, Scott DH. Pulmonary artery blood temperature and the measurement of cardiac output by thermodilution. Anaesthesia. 2002;57(6):562.CrossRefPubMedGoogle Scholar
  10. 10.
    Richard C, Warszawskj J, ANguel N, Deye N, Combes A, Barnoud D, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2003;290:2713–20.  https://doi.org/10.1001/jama.290.20.2713. CrossRefPubMedGoogle Scholar
  11. 11.
    Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Melbourne D, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomized controlled trial. Lancet. 2005;366:472–7.  https://doi.org/10.1016/S0140-6736(05)67061-4.CrossRefPubMedGoogle Scholar
  12. 12.
    Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary-artery catheter in high risk surgical patients. N Engl J Med. 2003;348:5–14.  https://doi.org/10.1056/NEJMoa021108.CrossRefPubMedGoogle Scholar
  13. 13.
    Wheeler AP, Bernard GR, Thompson BT, Shoenfeld D, Wiedmann HP, deBoisblanc B, et al. Pulmonary artery versus central venous catheter to guide treatment of acute lung injury. National Heart, Lung and Blood Institute Acute Respiratory Distress Syndrome (ARDS). N Engl J Med. 2006;354:2213–24.  https://doi.org/10.1056/NEJMoa061895. CrossRefPubMedGoogle Scholar
  14. 14.
    McGee WT, Headley JM, Frazier JA. Quick guide to cardiopulmonary care. 2014. http://ht.edwards.com/scin/edwards/eu/sitecollectionimages/products/pressuremonitoring/ar11206-quickguide3rded.pdf. Accessed 7 Nov 2016.
  15. 15.
    Cottis R, Magee N, Higgins DJ. Haemodynamic monitoring with pulse-induced contour cardiac output (PiCCO) in critical care. Intensive Crit Care Nurs. 2003;19:301–7.CrossRefPubMedGoogle Scholar
  16. 16.
    de Waal EE, Wappler F, Buhre WF. Cardiac output monitoring. Curr Opin Anaesthesiol. 2009;22:71–7.  https://doi.org/10.1097/ACO.0b013e32831f44d0.CrossRefPubMedGoogle Scholar
  17. 17.
    Mayer J, Suttner S. Cardiac output derived from arterial pressure waveform. Curr Opin Anaesthesiol. 2009;22:804–8.  https://doi.org/10.1097/ACO.0b013e328332a473.CrossRefPubMedGoogle Scholar
  18. 18.
    Sakka SG. Hemodynamic monitoring in the critically ill patient—current status and perspective. Front Med. 2015;2:44.  https://doi.org/10.3389/fmed.2015.00044.CrossRefGoogle Scholar
  19. 19.
    McGhee BH, Bridges EJ. Monitoring arterial blood pressure: what you may not know. Crit Care Nurse. 2002;22:60–4, 66–70. 73 passimGoogle Scholar
  20. 20.
    Pittman JA, Ping JS, Mark JB. Arterial and central venous pressure monitoring. Int Anesthesiol Clin. 2004;42:13–30.CrossRefPubMedGoogle Scholar
  21. 21.
    Augusto JF, Teboul JL, Radermacher P, Asfar P. Interpretation of blood pressure signal: physiological bases, clinical relevance, and objectives during shock states. Intensive Care Med. 2011;37:411–9.  https://doi.org/10.1007/s00134-010-2092-1.CrossRefPubMedGoogle Scholar
  22. 22.
    Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121:2000–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Keckeisen M. Monitoring pulmonary artery pressure. Crit Care Nurse. 2004;24:67–70.Google Scholar
  24. 24.
    Bridges EJ. Pulmonary artery pressure monitoring: when, how and what else to use. AACN Adv Crit Care. 2006;17:286–305.PubMedGoogle Scholar
  25. 25.
    Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62:D42–50.  https://doi.org/10.1016/j.jacc.2013.10.032.CrossRefPubMedGoogle Scholar
  26. 26.
    Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2013;62:D34–41.  https://doi.org/10.1016/j.jacc.2013.10.029.CrossRefPubMedGoogle Scholar
  27. 27.
    Goodrich C. Continuous central venous oximetry monitoring. Crit Care Nurs Clin North Am. 2006;18:203–209., x.  https://doi.org/10.1016/j.ccell.2006.01.005.CrossRefPubMedGoogle Scholar
  28. 28.
    Walley KR. Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med. 2011;184:514–20.  https://doi.org/10.1164/rccm.201010-1584CI.CrossRefPubMedGoogle Scholar
  29. 29.
    Kopterides P, Bonovas S, Mavrou I, Kostadima E, Zakynthinos E, Armaganidis A. Venous oxygen saturation and lactate gradient from superior vena cava to pulmonary artery in patients with septic shock. Shock. 2009;31:561–7.  https://doi.org/10.1097/SHK.0b013e31818bb8d8. CrossRefPubMedGoogle Scholar
  30. 30.
    Varpula M, Karlsson S, Ruokonen E, Pettilä V. Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock. Intensive Care Med. 2006;32:1336–43.  https://doi.org/10.1007/s00134-006-0270-y.CrossRefPubMedGoogle Scholar
  31. 31.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy collaborative group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77.  https://doi.org/10.1056/NEJMoa010307. CrossRefPubMedGoogle Scholar
  32. 32.
    Reid M. Central venous oxygen saturation: analysis, clinical use and effects on mortality. Nurs Crit Care. 2013;18:245–50.  https://doi.org/10.1111/nicc.12028. CrossRefPubMedGoogle Scholar
  33. 33.
    Perz S, Uhlig T, Kohl M, Bredle DL, Reinhart K, Bauer M, Kortgen A. Low and supranormal central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study. Intensive Care Med. 2011;37:52–9.  https://doi.org/10.1007/s00134-010-1980-8.CrossRefPubMedGoogle Scholar
  34. 34.
    Magder S. How to use central venous pressure measurements. Curr Opin Crit Care. 2005;11:264–70.CrossRefPubMedGoogle Scholar
  35. 35.
    Magder S. Central venous pressure monitoring. Curr Opin Crit Care. 2006;12:219–27.  https://doi.org/10.1097/01.ccx.0000224866.01453.43.CrossRefPubMedGoogle Scholar
  36. 36.
    Robin E, Costecalde M, Lebuffe G, Vallet B. Clinical relevance of data from the pulmonary artery catheter. Crit Care. 2006;10(Suppl 3):S3.  https://doi.org/10.1186/cc4830.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sakka SG, Rühl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, et al. Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med. 2000;26:180–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Kapoor PM, Bhardwaj V, Sharma A, Kiran U. Global end-diastolic volume an emerging preload marker vis-a-vis other markers—have we reached our goal? Ann Card Anaesth. 2016;19:699–704.  https://doi.org/10.4103/0971-9784.191554.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Della Rocca G, Costa GM, Coccia C, Pompei L, Di Marco P, Pietropaoli P. Preload index: pulmonary artery occlusion pressure versus intrathoracic blood volume monitoring during lung transplantation. Anesth Analg. 2002;95:835–43.PubMedGoogle Scholar
  40. 40.
    Della Rocca G, Costa MG, Coccia C, Pompei L, Pietropaoli P. Preolad and haemodynamic assessment during liver transplantation: a comparison between the pulmonary artery catheter and transpulmonary indicator dilution technique. Eur J Anaesthesiol. 2002;19:868–75.CrossRefPubMedGoogle Scholar
  41. 41.
    Sakka SG, Bredle DL, Reinhart K, Meier-Hellmann A. Comparison between intrathoracic blood volume and cardiac filling pressures in the early phase of hemodynamic instability of patients with sepsis or septic shock. J Crit Care. 1999;14:78–83.CrossRefPubMedGoogle Scholar
  42. 42.
    Lange NR, Schuster DP. The measurement of lung water. Crit Care. 1999;3:R19–24.  https://doi.org/10.1186/cc342.DOI:10.1186/cc342.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Shyamsundar M, Attwood B, Keating L, Walden AP. Clinical review: the role of ultrasound in estimating extra-vascular lung water. Crit Care. 2013;17:237.  https://doi.org/10.1186/cc12710.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Volpicelli G, Skurzak S, Boero E, Carpinteri G, Tengattini M, Stefanone V, et al. Lung ultrasound predicts well extravascular lung water but is of limited usefulness in the prediction of wedge pressure. Anesthesiology. 2014;121:320–7.  https://doi.org/10.1097/ALN.0000000000000300.CrossRefPubMedGoogle Scholar
  45. 45.
    Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care. 2015;5:38.  https://doi.org/10.1186/s13613-015-0081-9.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Tagami T, Kushimoto S, Yamamoto Y, Atsumi T, Tosa R, Matsuda K, et al. Validation of extravascular lung water measurement by single transpulmonary thermodilution: human autopsy study. Crit Care. 2010;14:R162.  https://doi.org/10.1186/cc9250.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Tagami T, Sawabe M, Kushimoto S, Marik PE, Mieno MN, Kawaguchi T, et al. Quantitative diagnosis of diffuse alveolar damage using extravascular lung water. Crit Care Med. 2013;41(9):2144–50.  https://doi.org/10.1097/CCM.0b013e31828a4643.CrossRefPubMedGoogle Scholar
  48. 48.
    Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, et al. Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury. Crit Care Med. 2010;38:114–20.  https://doi.org/10.1097/CCM.0b013e3181b43050.CrossRefPubMedGoogle Scholar
  49. 49.
    Huber W, Mair S, Götz SQ, Tschirdewahn J, Siegel J, Schmid RM, et al. Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients. Intensive Care Med. 2013;39:146–50.  https://doi.org/10.1007/s00134-012-2745-3.CrossRefPubMedGoogle Scholar
  50. 50.
    Sakka SG, Klein M, Reinhart K, et al. Prognostic value of extravascular lung water in critically ill patients. Chest. 2002;122:2080–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Mitchell JP, Schuller D, Calandrino FS, Schuster DP. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis. 1992;145:990–8.  https://doi.org/10.1164/ajrccm/145.5.990.CrossRefPubMedGoogle Scholar
  52. 52.
    Redondo Calvo FJ, Bejarano Ramirez N, Uña Orejon R, Villazala Garcia R, Yuste Peña AS, et al. Elevated extravascular lung water index (ELWI) as a predictor of failure of continuous positive airway pressure via helmet (helmet-CPAP) in patients with acute respiratory failure after major surgery. Arch Bronconeumol. 2015;51:558–63.  https://doi.org/10.1016/j.arbres.2015.01.012. CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University Anesthesia and Intensive Care Unit, University Hospital S. Maria della MisericordiaUdineItaly
  2. 2.General Intensive Care UnitSan Gerardo Hospital, ASST Monza, University of Milano-BicoccaMilanItaly

Personalised recommendations