Rationale for Hemodynamic Monitoring

  • J. A. Kellum
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 28)


While the history of formal hemodynamic monitoring is relatively brief [2], an appreciation for the qualitative aspects of monitoring dates back to ancient times [1]. In one sense, hemodynamic monitoring is a natural extension of the physical examination, quantifying the various aspects of the physical assessment. For instance, methods to assess central venous pressure by examination of the neck veins were developed long before the routine use of central venous catheters. However, in the modern ICU’s of today, hemodynamic monitoring is not used merely as a tool for the validation of the physical exam or for the periodic detailed assessment, but instead, on a continuous basis. Indeed, it is this feature that accounts for much of the utility of hemodynamic monitoring.


Oxygen Transport Organ Injury Regional Blood Flow Hemodynamic Monitoring Organ Blood Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bellamy RF, Maningas PA, Wenger BA (1986) Current Shock Models and Clinical Correlations. Ann Emerg Med 15:139–1395.Google Scholar
  2. 2.
    Nelson LD, Rutherford EJ (1993) Principles of hemodynamic monitoring. In: Pinsky MR, Dhainaut J-F (eds) Pathophysiologic Foundations of Critical Care. Williams & Wilkins, Baltimore, pp 3–22.Google Scholar
  3. 3.
    Polk SL, Roizen MF (1990) Cost-benefit analysis in monitoring. In: Blitt CD (ed) Monitoring in Anesthesia and Critical Care Medicine. Churchill Livingstone, New York, pp 65–77.Google Scholar
  4. 4.
    Connors AF Jr, McCaffree DR, Gray BA (1983) Evaluation of right-heart catheterization in the critically ill patient without acute myocardial infarction. N Engl J Med 308:263–271.PubMedCrossRefGoogle Scholar
  5. 5.
    Moore CH, Lombardo TR, Allums JA, et al. (1978) Left main coronary artery stenosis: hemodynamic monitoring to reduce mortality. Ann Thorac Surg 26:445–452.PubMedCrossRefGoogle Scholar
  6. 6.
    Shoemaker WC, Montgomery ES, Kaplan E, et al. (1973) Physiologic patterns in surviving and non-surviving shock patients. Arch Surg 106:630–639.PubMedGoogle Scholar
  7. 7.
    Hopkins JA, Shoemaker WC, Chang PC, et al. (1983) Clinical trial of an emergency resuscitation algorithm. Crit Care Med 22:621–628.CrossRefGoogle Scholar
  8. 8.
    Shoemaker WC (1987) The role of oxygen transport patterns in the pathophysiology, prediction of outcome and therapy of shock. In: Bryan-Brown CW, Ayres SM (eds) New Horizons II: Oxygen Transport and Utilization. Fullerton, Society of Critical Care Medicine, p 65.Google Scholar
  9. 9.
    Hinds C, Watson D (1995) Manipulating hemodynamics and oxygen transport in critically ill patients. NEJM 333:1074–1075.PubMedCrossRefGoogle Scholar
  10. 10.
    Pinsky MR, Matuschak GM (1990) Multiple systems organ failure: a unifying hypothesis. J Crit Care 5:108–114.CrossRefGoogle Scholar
  11. 11.
    Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186.PubMedCrossRefGoogle Scholar
  12. 12.
    Tuchsmidt J, Fired J, Astriz M, Rackow E (1992) Evaluation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 102:216–220.CrossRefGoogle Scholar
  13. 13.
    Boyd O, Grounds RM, Bennett ED (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270:2699–2707.PubMedCrossRefGoogle Scholar
  14. 14.
    Hayes MA, Timmins AC, Yau EHS, et al. (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722.PubMedCrossRefGoogle Scholar
  15. 15.
    Gattinoni L, Brazzi L, Pelosi P, et al. (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333:1025–1032.PubMedCrossRefGoogle Scholar
  16. 16.
    Robin ED (1983) A critical look at critical care. Crit Care Med 11:144–152.PubMedCrossRefGoogle Scholar
  17. 17.
    Meador CK (1965) The art and science of non-disease. N Engl J Med 272:92–101.PubMedCrossRefGoogle Scholar
  18. 18.
    Kleinman B (1989) Understanding natural frequency and damping and how they relate to the measurement of blood pressure. J Clin Monit 5:137–147.PubMedCrossRefGoogle Scholar
  19. Bellomo R, Pinsky MR (1996) Invasive monitoring. In: Tinker J, Browne D, Sibbald W (eds) Critical Care - Standards Audit and Ethics. Arnold Publishing, pp 82–104. Google Scholar
  20. 20.
    Bryan-Brown CW (1992) Pathway to the present: a personal view of critical care. In: Civetta JM, Taylor RW, Kirby RR (eds) Critical Care. JB Lippincott, Philadelphia, pp 5–12.Google Scholar
  21. 21.
    Pinsky MR (1994) Beyond global 02 supply-demand relations: in search of measures of dys-oxia. Intensive Care Med 20:1–3.PubMedCrossRefGoogle Scholar
  22. 22.
    Cain S (1978) Effects of time and vasoconstrictor tone on oxygen extraction during hypoxic hypoxia. J Appl Physiol 45:219–224.PubMedGoogle Scholar
  23. 23.
    Kramer DJ, Stein KL, Schlichtig RA, Armendariz E, Lanier A, Pinsky MR (1989) Pressure flow relationships in the superior mesenteric and hepatic arteries in endotoxic shock. Chest 96: 2933–2939.Google Scholar
  24. 24.
    Berdenheur H, Schrader J (1986) Supply-to-demand ratio for oxygen determines formation of adenosine by the heart. Am J Physiol 250: H162–H173.Google Scholar
  25. 25.
    Shoemaker WC, Kram HB, Appel PL, Fleming AW (1990) The efficacy of central venous and pulmonary artery catheters and therapy based upon them in reducing mortality and morbidity. Arch Surg 125:1332–1338.PubMedGoogle Scholar
  26. 26.
    Schlichtig R, Bowles SA (1994) Distinguishing between aerobic and anaerobic appearance of dissolved C02 in intestine during low flow. J Appi Physiol 76:2443–2451.Google Scholar
  27. 27.
    Kellum JA, Rico P, Pinsky MR (1996) Accuracy of pHi and delta PC02 for detecting gut hypoperfusion in acute canine endo toxemia. Am J Respir Crit Care Med 153: A659.Google Scholar

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© Springer-Verlag Berlin Heidelberg 1997

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  • J. A. Kellum

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