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Practical Issues of Hemodynamic Monitoring at the Bedside

Polanco, PM and Pinsky, MR (2006) Practical Issues of Hemodynamic Monitoring at the Bedside. Surgical Clinics of North America, 86 (6). 1431 - 1456. ISSN 0039-6109

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Abstract

All surgical patients require monitoring to assess cardiovascular stability, and sometimes may benefit from optimization of their hemodynamic status. Therefore, all surgeons require a basic understanding of physiological underpinnings of hemodynamic monitoring. The physiological rationale is still the primary level of defense for monitoring critically ill patients. Arterial catheterization to monitor arterial pressure is a safe procedure with a low complication rate; however, it should be used only when clear indications exist. There is no evidence that achieving pressures over 65 mm Hg increases organ perfusion or favors outcome. The analysis of pulse pressure variation is a useful method to assess preload responsiveness and a potential tool for resuscitation. CVP has been wrongly used as a parameter of goal for replacement of intravascular volume in shock patients. Volume loading in patients who have CVP greater than 12 mmHg is unlikely to increase cardiac output, and attempts to normalize CVP in early goal-directed therapy during resuscitation have no proven benefit. The use of PAC provides direct access to several physiological parameters, both as raw data and derived measurements (CO, SvO2, DO2). At present, targeting specific levels of DO2 has proven effective only in high-risk surgery patients in the perioperative time. Ppao is often used as a bedside assessment of pulmonary edema, pulmonary vasomotor tone, intravascular volume status, and LV preload and performance. Several publications have explored the potential indications and benefits of the PAC to direct goal therapies. Beyond this controversy, there is a trend toward less invasive methods of hemodynamic monitoring, and current data support protocols of monitoring and goal-directed therapy that could improve outcome in selected group of surgical patients. © 2006 Elsevier Inc. All rights reserved.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Polanco, PM
Pinsky, MRpinsky@pitt.eduPINSKY
Date: 1 December 2006
Date Type: Publication
Journal or Publication Title: Surgical Clinics of North America
Volume: 86
Number: 6
Page Range: 1431 - 1456
DOI or Unique Handle: 10.1016/j.suc.2006.09.003
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0039-6109
Article Type: Review
PubMed ID: 17116456
Date Deposited: 14 Jul 2012 18:59
Last Modified: 18 Mar 2019 13:55
URI: http://d-scholarship.pitt.edu/id/eprint/12431

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