Pearls and Pitfalls
Normal vital signs do not equate to circulatory adequacy.
Tachycardia indicates a loss of 15–30% of blood volume, but can be blunted in the elderly, the athlete, pregnant women, and patients medicated with beta-blockers.
Automated blood pressure devices lack accuracy when the systolic blood pressure is below 110 mmHg; use of a manual device in these settings is recommended.
Monitor the mean arterial pressure (MAP), NOT the systolic blood pressure.
Measure central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) at end expiration.
Beware that base deficits and lactic acidosis do not always occur secondary to hypoxia.
Use oxygen delivery (DO2) as a guide, not as an endpoint.
Introduction
The fundamental goal of circulatory monitoring is to assess the adequacy of tissue perfusion. At first glance, this would appear to be relatively straightforward – heart rate and blood pressure are easy to assess and to interpret. However, neither accurately...
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Selected Readings
Abramson D, Scalea TM, Hitchcock R, et al. (1993) Lactate clearance and survival following injury. J Trauma 35:584–588
American College of Surgeons' Committee on Trauma (2004) Advanced Trauma Life Support for Doctors (ATLS) Student manual, 7th edn. American College of Surgeons, Chicago, IL
Balogh Z, McKinley MA, Cocanour CS, et al. (2003) Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 138:637–642
Bishop MH, Shoemaker WC, Appel PL, et al. (1993) Relationship between supranormal circulatory values, time delays, and outcomes in severely traumatized patients. Crit Care Med 21:56–63
Boyd O (2000) The high risk surgical patient: where are we now? Clin Intensive Care Special Issue:3–10
Burchard KW, Gann DS, Wiles CE (2000) The circulation, ch. 2. In: Burchard KW, Gann DS, Wiles CE (eds) The clinical handbook for surgical critical care. Parthenon, New York
Davis JW, Davis IC, Bennink LD, et al. (2003) Are automated blood pressure measurements accurate in trauma patients? J Trauma 55:860–863
Davis JW, Shackford SR, Holbrook TL (1991) Base deficit as a sensitive indicator of compensated shock and tissue oxygen utilization. Surg Gynecol Obstret 173:473
Davis JW, Shackford SR, Mackersie RC, et al. (1988) Base deficit as a guide to volume resuscitation. J. Trauma 28:146
DuBose, Thomas D Jr (1998) Acidosis and alkalosis, ch. 50. In: Fauci AS, Braunwald E, Isselbacher KJ, et al. (eds) Harrison's principles of internal medicine, 14th edn. McGraw Hill, New York, pp 279–280
Elliott DC (1998) An evaluation of the endpoints of resuscitation. J Am Coll Surg 187:536–547
Friedman G, et al. (1995) Combined measurements of blood lactate concentrations and gastric intramucosal pH in patients with severe sepsis. Crit Care Med 23:1184–1193
Marino PL (1998) Hemodynamic monitoring, sec. 3. In: Marino PL (ed) The ICU book, 2nd edn. Williams & Wilkins, Baltimore, MD
Holcroft JW, Anderson JT (2005) Cardiopulmonary monitoring, sec. 6, ch. 4. In: American College of Surgeons (eds) ACS surgery principles and practice. WebMD Publishing, New York
Iberti TJ, et al. (1990) A multicenter study of physicians' knowledge of the pulmonary artery catheter. JAMA 264:2928–2932
Keenan, SP (2002) Use of ultrasound to place central lines. J Crit Care 17:126–137
Kern JW, Shoemaker WC (2002) Meta-analysis of hemodynamic optimization in high-risk patients. Crit Care Med 30:1686–1692
Moore FA, Haenel JB, Moore EE, et al. (1992) Incommensurate oxygen consumption in response to maximal oxygen availability predicts post-injury multiple organ failure. J Trauma 33:58–66
Shah MR et al. (2005) Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 294:1664–1670
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer Science+Business Media, LLC
About this entry
Cite this entry
Mahoney, E.J., Biffl, W.L., Cioffi, W.G. (2009). Circulatory Monitoring. In: Bland, K.I., Büchler, M.W., Csendes, A., Sarr, M.G., Garden, O.J., Wong, J. (eds) General Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-833-3_6
Download citation
DOI: https://doi.org/10.1007/978-1-84628-833-3_6
Publisher Name: Springer, London
Print ISBN: 978-1-84628-832-6
Online ISBN: 978-1-84628-833-3
eBook Packages: MedicineReference Module Medicine