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Hemodynamic Monitoring and Resuscitation

  • Patrick J. Neligan
  • Jiri Horak
Chapter

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.

Keywords

Shock Sepsis Stress Stress response Resuscitation Fluid Fluid responsiveness FOCUS CVP PCWP Stroke volume variability Pulse pressure variability Passive leg raising End-expiratory occlusion test 

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Authors and Affiliations

  1. 1.Anaesthesia & Intensive CareGalway University HospitalsGalwayIreland
  2. 2.Department of Anesthesiology and Critical CareHospital of the University of PennsylvaniaPhiladelphiaUSA

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