Hemodynamic Monitoring

  • Ubaldo J. Martin
  • Montserrat Diaz-Abad
  • Samuel L. Krachman


After studying this chapter, you should be able to: Understand the indications for placing arterial, central venous, and pulmonary artery catheters (PAC). Select catheter placement sites, based on patient characteristics and relative risk for complications. Establish a differential diagnosis based on the PAC measured and derived parameters. Understand the role of the PAC in managing and diagnosing specific critical care conditions. Interpret pulmonary artery (PA) waveforms and their significance. Understand the controversies associated with PAC use.


Right Ventricular Acute Respiratory Distress Syndrome Central Venous Pressure Internal Jugular Vein Tricuspid Regurgitation 


  1. 1.
    O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for disease control and prevention. MMWR Recomm Rep. 2002;51(RR-10):1-29.PubMedGoogle Scholar
  2. 2.
    Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286:700-707.PubMedCrossRefGoogle Scholar
  3. 3.
    Magder S, Georgiadis G, Cheone T. Respiratory variations in right atrial pressure predict the response to fluid challenge. J Crit Care. 1992;7:76-85.CrossRefGoogle Scholar
  4. 4.
    Reuse C, Vincent JL, Pinsky MR. Measurements of right ventricular volumes during fluid challenge. Chest. 1990;98:1450-1454.PubMedCrossRefGoogle Scholar
  5. 5.
    Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-1377.PubMedCrossRefGoogle Scholar
  6. 6.
    Jones AE, Focht A, Horton JM, et al. Prospective external validation of the clinical effectiveness of the emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock. Chest. 2007;132:425-432.PubMedCrossRefGoogle Scholar
  7. 7.
    Sebat F, Musthafa AA, Johnson D, et al. Effect of a rapid response system for patients in shock on time to treatment and mortality during 5 years. Crit Care Med. 2007;35:2568-2575.PubMedCrossRefGoogle Scholar
  8. 8.
    Swan HJC, Ganz W, Forrester JS, et al. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970;283:447-451.PubMedCrossRefGoogle Scholar
  9. 9.
    Connors AF Jr, McCaffree DR, Gray BA. Evaluation of right heart catheterization in the critically ill patients without acute myocardial infarction. N Engl J Med. 1983;308:263-267.PubMedCrossRefGoogle Scholar
  10. 10.
    Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med. 1984;12:549-553.PubMedCrossRefGoogle Scholar
  11. 11.
    Mattthay M, Eschenbacher W, Goetzle E. Elevated concentrations of leukotriene D4 in pulmonary edema fluid of patients with adult respiratory disease syndrome. J Clin Immunol. 1984;4: 479-483.CrossRefGoogle Scholar
  12. 12.
    Wheeler AP, Bernard GR, Thompson BT, 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) clinical trials network. N Engl J Med. 2006;354:2213-2224.PubMedCrossRefGoogle Scholar
  13. 13.
    Richard C, Warszawski J, Anguel N, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized trial. JAMA. 2003;290:2713-2720.CrossRefGoogle Scholar
  14. 14.
    Harvey S, Harrison DA, Singer M, 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;366:472-477.PubMedCrossRefGoogle Scholar
  15. 15.
    Shah MR, Hasselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA. 2005;294:1664-1670.PubMedCrossRefGoogle Scholar
  16. 16.
    Dantzker D, Brook CJ, Dehart P. Ventilation-perfusion distribution in adult reparatory distress syndrome. Am Rev Respir Dis. 1979;120:1039-1052.PubMedGoogle Scholar
  17. 17.
    The ESCAPE investigators and ESCAPE study coordinators. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. 2005; 294:1625-1633.CrossRefGoogle Scholar
  18. 18.
    Moore CH, Lombardo TR, Allums JA, et al. Left main coronary artery stenosis: hemodynamic monitoring to reduce mortality. Ann Thorac Surg. 1978;26:445-449.PubMedCrossRefGoogle Scholar
  19. 19.
    Berlauk JF, Abrams JH, Gilmor IJ, et al. Preoperative optimization of preoperative hemodynamic improves outcome in peripheral vascular surgery. Ann Surg. 1991;214:289-297.PubMedCrossRefGoogle Scholar
  20. 20.
    Isaacson IJ, Lowdon JD, Berry AJ, et al. The value of pulmonary artery and central venous monitoring in patients undergoing abdominal aortic reconstructive surgery. J Vasc Surg. 1990; 12:754-760.PubMedCrossRefGoogle Scholar
  21. 21.
    Shoemaker WC, Appel PL, Kram HB, et al. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest. 1988;94:1176-1186.PubMedCrossRefGoogle Scholar
  22. 22.
    Hayes MA, Timmins AC, Yau EHS, et al. Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med. 1994;330:1717-1722.PubMedCrossRefGoogle Scholar
  23. 23.
    Gattinoni L, Brazzi L, Pelosi P, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med. 1995;333:1025-1032.PubMedCrossRefGoogle Scholar
  24. 24.
    Mira JP, Fabre JE, Baigorri F, et al. Lack of oxygen supply dependency in patients with severe sepsis. Chest. 1994;106:1524-1531.PubMedCrossRefGoogle Scholar
  25. 25.
    Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of pulmonary artery catheters in high-risk surgical patients. N Engl J Med. 2003;348:5-14.PubMedCrossRefGoogle Scholar
  26. 26.
    Magder S, Georgiadis G, Cheone T. Respiratory variations in right atrial pressure predict the response to fluid challenge. J Crit Care. 1992;7:76-85.CrossRefGoogle Scholar
  27. 27.
    Taboul JL, Zapol WH, Brun-Buisson C, et al. A comparison of pulmonary artery occlusion pressure and left ventricular end-diastolic pressure during mechanical ventilation with PEEP in patients with severe ARDS. Anethesiology. 1989;70:261-266.CrossRefGoogle Scholar
  28. 28.
    Yellin LB, Filler JJ, Barnette RE. Nominal hemoptysis heralds pulmonary artery catheter-induced pseudoaneurysm. Anesthesiology. 1991;74:370-373.PubMedCrossRefGoogle Scholar

Additional Reading

  1. Lodato RF. Use of the pulmonary artery catheter. Semin Respir Crit Care. 1999;20:29-42.CrossRefGoogle Scholar
  2. O’Quinn R, Marini JJ. Pulmonary artery occlusion pressure: clinical physiology, measurement, and interpretation. Am Rev Respir Dis. 1983;128:319-326.Google Scholar
  3. Pepe PE, Marini JJ. Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: the autoPEEP effect. Am Rev Respir Disease. 1982;126:166-170.Google Scholar
  4. Zapol WM, Snider MT. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med. 1977;296:476-480.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Ubaldo J. Martin
    • 1
  • Montserrat Diaz-Abad
    • 2
  • Samuel L. Krachman
    • 1
  1. 1.Division of Pulmonary and Critical Care MedicineTemple University School of MedicinePhiladelphiaUSA
  2. 2.Department of Pulmonary and Critical CareUniversity of Maryland School of MedicineBaltimoreUSA

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