Non-Invasive Hemodynamic and Metabolic Monitoring

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


Monitoring of the circulation and metabolic status plays a central role in the management of critically ill patients. Mostly, monitoring is indicated in case of circulatory insufficiency, and consists of continuous or intermittent measurement of blood pressures and flows with help of arterial and central venous or pulmonary artery (PA) catheters, and of urinary flow via a bladder catheter. It has been doubted, however, whether the clinical benefits of insertion of a PA catheter, an invasive procedure not without risks, is outweighed by the detriments. This is mainly caused by the uncertainty whether hemodynamic variables are true indicators of the severity, course and outcome of the shock syndrome, whether some parameters are of greater significance than others, and whether treatment guided by presumed prognostically important variables indeed improves survival. Also, interpretation of PA catheter variables can be difficult, as, for instance, the filling pressures of the heart may hardly reflect end-diastolic volumes of the ventricles, which are more direct indicators of ventricular preload. Hence, non-invasive imaging techniques, such as nuclear angiography and echocardiography have been used to circumvent the complications of invasive procedures, and to estimate cardiac loading and contractility, in order to supplement invasive hemodynamic data in difficult to diagnose and to treat cases. Cardiac output can also be estimated by other non-invasive, mostly (semi)continuous means, some of which have been applied in the intensive care unit.


Cardiac Output Adult Respiratory Distress Syndrome Impedance Cardiography Cardiac Output Measurement Thermodilution Cardiac Output 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Perel A (1995) Cardiovascular assessment in ventilated patients by arterial pressure waveform analysis. Crit Care Intern 11/12:18–19.Google Scholar
  2. 2.
    Coriat P, Vrillon M, Perel A, Baron JF, Le Bret F, Saada M, Viars P (1994) A comparison of systolic blood pressure variations and echocardiographic estimates of end-diastolic left ventricular size in patients after aortic surgery. Anesth Analg 78:46–53.PubMedCrossRefGoogle Scholar
  3. 3.
    Dobb GJ, Donovan KD (1987) Non-invasive methods of measuring cardiac output. Intens Care Med 13:304–309.Google Scholar
  4. 4.
    Shephard JN, Brecker SJ, Evans TW (1994) Bedside assessment of myocardial performance in the critically ill. Intens Care Med 20:513–521.CrossRefGoogle Scholar
  5. 5.
    Goldstein M, Vincent J-L, Kahn RJ (1988) Evaluation of cardiac function by echo-Doppler studies in critically ill patients. Intens Care Med 14:406–410.CrossRefGoogle Scholar
  6. 6.
    Wong DH, Mahutte CK (1990) Two-beam pulsed Doppler cardiac measurement: reproducibility and agreement with thermodilution. Crit Care Med 18:433–437.PubMedCrossRefGoogle Scholar
  7. 7.
    Singer M, Bennett ED (1991) Noninvasive optimmization of left ventricular filling using esophageal Doppler. Crit Care Med 19:1132–1137.PubMedCrossRefGoogle Scholar
  8. 8.
    Lu C, Nicolosi GL, Burelli C, Cassin M, Zardo F, Brieda M, Cervesato E, Zanuttini D (1992) Limitations in the assessment of changes of cardiac output by Doppler echocardiography under various hemodynamic conditions. Am J Cardiol 70:1370–1374.PubMedCrossRefGoogle Scholar
  9. 9.
    Stoddard MF, Prince CR, Ammash N, Goad JL, Vogel RL (1993) Pulsed Doppler transesophageal echocardiographic determination of cardiac output in human beings: comparison with thermodilution technique. Am Heart J 126:956–962.PubMedCrossRefGoogle Scholar
  10. 10.
    Katz WE, Gasior TA, Quinlan JJ, Gorscan J (1993) Trangastric continuous-wave Doppler to determine cardiac output. Am J Cardiol 71:853–856.PubMedCrossRefGoogle Scholar
  11. 11.
    Jardin F, Valtier B, Beauchet A, Dubourg O, Bourdarias JP (1994) Invasive monitoring combined with two-dimensional echocardiographic study in septic shock. Intens Care Med 20: 550–554.CrossRefGoogle Scholar
  12. 12.
    Wilson AF (1995) Noninvasive measurement of cardiac output. Cardiologia 40:551–559.PubMedGoogle Scholar
  13. 13.
    Poelaert JI, Trouerbach J, De Buijzere M, Everaert J, Colardyn FA (1995) Evaluation of transesophageal echocardiography as a diagnostic and therapeutic aid in a critical care setting. Chest 1907:774–779.CrossRefGoogle Scholar
  14. 14.
    Feinberg MS, Hopkins WE, Davila-Roman VG, Barzilai B (1995) Multiplane transesophageal echocardiographic Doppler imaging accurately determines cardiac output measurements in critically ill patients. Chest 107:769–773.PubMedCrossRefGoogle Scholar
  15. 15.
    Alam M (1996) Transesophageal echocardiography in critical care units: Henry Ford Hospital experience and review of the literature. Progr Cardiovasc Dis 38:315–328.CrossRefGoogle Scholar
  16. 16.
    McLean AS (1996) Echocardiography in the intensive care unit. Intens Care World 13:12–17.Google Scholar
  17. 17.
    Gorscan J (1995) Quantification of left ventricular function using transesophageal echocardiography. In: Vincent J-L (ed) Yearbook of Intensive Care and Emergency Medicine. Springer Verlag, Berlin Heidelberg New York, pp 575–592.Google Scholar
  18. 18.
    Castor G, Kloeke RK, Stoll M, Helms J, Niermark I (1994) Simultaneous measurement of cardiac output by thermodilution, thoracic electrical bioimpedance and Doppler ultrasound. Br JAnaesth 72:133–138.CrossRefGoogle Scholar
  19. 19.
    Sajkov D, Cowie RJ, Bradley JA, Mahar L, McEvoy RD (1993) Validation of new pulsed Doppler echocardiographic techniques for assessment of pulmonary hemodynamics. Chest 103:1348–1353.PubMedCrossRefGoogle Scholar
  20. 20.
    Khoury AF, Afridi I, Quinones MA, Zoghbi WA (1994) Transesophageal echocardiography in critically ill patients: feasibility, safety, and impact on management. Am Heart J 127: 1363–1371.PubMedCrossRefGoogle Scholar
  21. 21.
    Kaul S, Stratienko AA, Pollock SG, Marieb MA, Keller MW, Sabia PJ (1994) Value of two-dimensional echocardiography for determining the basis of hemodynamic compromise in critically ill patients: a prospective study. J Am Soc Echocardiography 7:598–606.Google Scholar
  22. 22.
    Patel JJ, Chandrasekaran K, Maniet AR, Ross JJ, Weiss RL, Guidotti JA (1994) Impact of the incidental diagnosis of clinically unsuspected central pulmonary artery thromboembolism in treatment of critically ill patients. Chest 105:986–990.PubMedCrossRefGoogle Scholar
  23. 23.
    Banning AP, Masani ND, Ikram S, Fraser AG, Hall RJC (1994) Transoesophageal echocardiography as the sole diagnostic investigation in patients with suspected thoracic aortic dissection. Br Heart J 72:461–465.PubMedCrossRefGoogle Scholar
  24. 24.
    Poelaert JI, Viser CA, Everaert JA, Kooien J J, Colardyn FA (1993) Acute hemodynamic changes of pressure-controlled inverse ratio ventilation in the adult respiratory distress syndrome. A transesophageal echocardiographic and Doppler study. Chest 104:214–219.Google Scholar
  25. 25.
    Schneider AJ, Teule GJJ, Groeneveld ABJ, Nauta JJP, Heidendal GAK, Thijs LG (1988) Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study. Am Heart J 116:103–112.PubMedCrossRefGoogle Scholar
  26. 26.
    Raijmakers PGHM, Groeneveld ABJ, Teule GJJ, Thijs LG. The diagnostic value of the 67Gallium pulmonary leak index in pulmonary edema. J Nucl Med (In press).Google Scholar
  27. 27.
    White SW, Quail AW, De Leeuw PW, Traugott FM, Brown WJ, Porges WL, Cottee DB (1990) Impedance cardiography for cardiac output measurement: an evaluation of accuracy and limitations. Eur Heart J 11:79–92.PubMedGoogle Scholar
  28. 28.
    Shoemaker WC, Wo CCJ, Bishop MH, Appel PL, Van de Water JM, Harrington GR, Wang X, Path RS (1994) Multicenter trial of a new thoracic electrical bioimpedance device for cardiac output estimation. Crit Care Med 22:1907–1912.Google Scholar
  29. 29.
    Doehring L, Lum E, Dracup K, Friedman A (1995) Predictors of between-method differences in cardiac output measurement using thoracic electrical bioimpedance and thermodilution. Crit Care Med 23:1667–1673.CrossRefGoogle Scholar
  30. 30.
    Weiss S, Calloway E, Cairo J, Granger W, Winslow J (1995) Comparison of cardiac output measurements by thermodilution and thoracic electrical bioimpedance in critically ill versus non-critically ill patients. Am J Emerg Med 13:626–631.PubMedCrossRefGoogle Scholar
  31. 31.
    Jónsson F, Madsen P, Jorgensen LG, Lunding M, Secher NH (1995) Thoracic electrical impedance and fluid balance during aortic surgery. Acta Anaesthesiol Scand 39:513–517.PubMedCrossRefGoogle Scholar
  32. 32.
    Van der Meer NJM, De Vries PMJ (1995) Impedance cardiography: non-invasive monitoring of hemodynamics in the ICU. In: Vincent J-L (ed) Yearbook of Intensive Care and Emergency Medicine. Springer Verlag, Berlin Heidelberg New York, pp 615–628.Google Scholar
  33. 33.
    Roos AN, Westendorp RGJ, Brand R, Souverijn JHM, Frölich M, Meinders AE (1995) Predictive value of tetrapolar body impedance measurements for hydration status in critically ill patients. Intens Care Med 21:125–131.CrossRefGoogle Scholar
  34. 34.
    Sackner MA, Hoffman RA, Krieger BP, Shaukat M, Stroh D, Sackner JD, Biziousky F, Brown J, Robinson J J (1991) Thoracocardiography. Part 2: Noninvasive measurement of changes in stroke volume; comparisons to impedance cardiography. Chest 99:896–903.PubMedCrossRefGoogle Scholar
  35. 35.
    Stok WJ, Baisch F, Hillebracht A, Schulz H, Meyer M, Karemaker JM (1993) Noninvasive cardiac output measurement by arterial pulse analysis compared with inert gas rebreathing. J Appi Physiol 74:2687–2693.Google Scholar
  36. 36.
    Bosman RJ, Stoutenbeek CP, Zandstra DF (1991) Noninvasive pulmonary blood flow measurement by means of C02 analysis of expiratory gases. Intens Care Med 17:98–102.CrossRefGoogle Scholar
  37. 37.
    Stevens PE, Gwyther SJ, Hanson ME, Boultbee JE, Kow WJ, Phillips ME (1990) Noninvasive monitoring of renal flow characteristics during acute renal failure in man. Intens Care Med 16:153–158.CrossRefGoogle Scholar
  38. 38.
    Petty GW, Wiebers DO, Meissner I (1990) Transcranial Doppler ultrasonography: clinical applications in cerebrovascular disease. Mayo Clin Proc 65:1350–1364.PubMedGoogle Scholar
  39. 39.
    Berré J, De Backer D, Moraine J-J, Vincent J-L, Kahn RJ (1994) Effects of dobutamine and prostacyclin on cerebral blood flow velocity in septic patients. J Crit Care 9:1–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Vincent J-L, Moraine J-J, Van der Linden P (1988) Toe temperature versus transcutaneous oxygen tension monitoring during acute circulatory failure. Intens Care Med 14:64–68.CrossRefGoogle Scholar
  41. 41.
    Schnapp LM, Cohen NH (1990) Pulse oximetry. Uses and abuses. Chest 98:1244–1250.Google Scholar
  42. 42.
    Imman KJ, Sibbald WJ, Rutledge FS, Speechley M, Martin CM, Clark BJ (1993) Does implementing pulse oximetry in a critical care unit result in substantial arterial blood gas savings? Chest 104:542–546.CrossRefGoogle Scholar
  43. 43.
    Makita K, Nunn JF, Royston B (1990) Evaluation of metabolic measuring instruments for use in critically ill patients. Crit Care Med 18:638–644.PubMedCrossRefGoogle Scholar
  44. 44.
    Ronco J J, Phang PT (1991) Validation of an indirect calorimeter to measure oxygen consumption in critically ill patients. J Crit Care 6:36–41.CrossRefGoogle Scholar
  45. 45.
    Ronco JJ, Fenwick JC, Tweeddale MG, Wiggs BR, Phang PT, Cooper DJ, Cunningham KF, Russell JA, Walley KR (1993) Identification of the critical oxygen delivery for anaerobic metabolism in critically ill septic and nonseptic humans. JAMA 270:1724–1730.PubMedCrossRefGoogle Scholar
  46. 46.
    Hanique G, Dugernier T, Laterre PF, Dougnac A, Roeseier J, Reynaert MS (1994) Significance of pathologic oxygen supply dependency in critically ill patients: comparison between measured and calculated methods. Intens Care Med 20:12–18.CrossRefGoogle Scholar
  47. 47.
    De Backer D, Moraine J-J, Berre J, Kahn RJ, Vincent J-L (1994) Effects of dobutamine on oxygen consumption in septic patients. Direct versus indirect determinations. Am J Respir Crit Care Med 150:95–100.Google Scholar
  48. 48.
    Carlon GC, Ray C, Miodownik SS, Kopec I, Groeger JS (1988) Capnography in mechanically ventilated patients. Crit Care Med 16:550–556.PubMedCrossRefGoogle Scholar
  49. 49.
    Falk JL, Rackow EC, Weil MH (1988) End-tidal carbon dioxide concentration during cardiopulmonary resuscitation. N Engl J Med 318:607–611.PubMedCrossRefGoogle Scholar
  50. 50.
    Kolkman JJ, Groeneveld AB J, Meuwissen SGM (1994) Effect of ranitidine on basal and bicarbonate-enhanced intragastric PC02: a tonometric study. Gut 35:737–741.PubMedCrossRefGoogle Scholar
  51. 51.
    Groeneveld AB J, Kolkman JJ (1994) Splanchnic tonometry: a review of methodology, physiology and clinical applications. J Crit Care 9:198–210.PubMedCrossRefGoogle Scholar
  52. 52.
    Gutierrez G, Clark C, Brown SD, Price K, Ortiz L, Nelson C (1994) Effect of dobutamine on oxygen consumption and gastric mucosal pH in septic patients. Am J Respir Crit Care Med 150:324–329.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • A. B. J. Groeneveld

There are no affiliations available

Personalised recommendations