Functional Hemodynamic Monitoring

About this book

Hemodynamic monitoring is one of the major diagnostic tools available in the acute care setting to diagnose cardiovascular insufficiency and monitor changes over time in response to interventions. However, the rationale and efficacy of hemodynamic monitoring to affect outcome has come into question. We now have increasing evidence that outcome from critical illness can be improved by focused resuscitation based on existing hemodynamic monitoring, whereas non-specific aggressive resuscitation impairs survival. Thus, this book frames hemodynamic monitoring into a functional perspective wherein hemodynamic variables and physiology interact to derive performance and physiological reserve estimates that themselves drive treatment. This philosophy, as well as the limitations and applications of common and evolving hemodynamic measures and their focused use in the care of critically ill patients are discussed, relevant to one underlying truth: No monitoring device, no matter how simple or sophisticated, will improve patient-centered outcomes useless coupled to a treatment which, itself, improves outcome.

Written for:

Critical care physicians, physicians-in-training, physicians who manage critically ill patients: trauma surgeons, cardiac surgeons, pulmonary medicine physicians

Keywords:

• cardiac output
• circulatory shock
• hemodynamic monitoring
• invasive monitoring
• resuscitation

Table of contents

Introduction
Functional Hemodynamic Monitoring: Foundations and Future (M.R. Pinsky and D. Payen).-
Therapeutic Goals
Defining Hemodynamic Instability (M. H. Weil).- Determinants of Blood Flow and Organ Perfusion (E. Calzia, Z. Iványi, and P. Radermacher).- Determining Effectiveness of Regional Perfusion (D. Payen).- Microcirculatory and Mitochondrial Distress Syndrome (MMDS): A New Look at Sepsis (P. E. Spronk, V. S. Kanoore-Edul, and C. Ince).- ‘Adequate’ Hemodynamics: A Question of Time? (L. Gattinoni, F. Valenza, and E. Carlesso).-
Limits and Applications of Hemodynamic Monitoring
Arterial Pressure: A Personal View (D. Bennett).- Central Venous Pressure: Uses and Limitations (T. Smith, R.M. Grounds, and A. Rhodes).- Pulmonary Artery Occlusion Pressure: Measurement, Significance, and Clinical Uses (J.J. Marini and J. W. Leatherman).- Cardiac Output by Thermodilution and Arterial Pulse Contour Techniques (J. Jansen and P.C.M. van den Berg).- Clinical Value of Intrathoracic Volumes from Transpulmonary Indicator Dilution (J. Groeneveld, R.M. Breukers, and J. Verheij).- Methodology and Value of Assessing Extravascular Lung Water (J. Groeneveld and J. Verheij).- Arterial Pulse Contour Analysis: Applicability to Clinical Routine (D.A. Reuter and A. Goetz).- Arterial Pulse Power Analysis: The LiDCOTMplus System (A. Rhodes and R. Sunderland).- Esophageal Doppler Monitoring (M. Singer).- Splanchnic Blood Flow (J. Creteur).-
Measurement of Oxygen Derived Variables and Cardiac Performance
Microcirculatory Blood Flow: Video Microscopy (D. De Backer).- Mixed Venous Oxygen Saturation (SvO2) (J. Hall).- Central Venous Oxygen Saturation (ScvO2) (K. Reinhart and F. Bloos).- VO2/DO2 Relationships (J.L. Vincent).- Cardiac Preload Evaluation Using Echocardiographic Techniques (M. Slama).- Right Ventricular End-diastolic Volume (J. Boldt).-
Assessment of Fluid Responsiveness
Volume Challenge in Tissue Hypoperfusion (P. Dellinger).- The Use of CVP in Critically Ill Patients (S. Magder).- Arterial Pressure Variation during Positive Pressure Ventilation (A. Perel, S. Preisman, and H. Berkenstadt).- Arterial Pulse Pressure Variation during Positive Pressure Ventilation and Passive Leg Raising (J.-L. Teboul, X Monnet, and C. Richard).-
Development of Treatment Algorithms
Standardization of Care by Defining End-points of Resuscitation (M. Mythen, H. Meeran, and M. Grocott).- Protocolized Cardiovascular Management based on Ventricular-arterial Coupling (M. R. Pinsky).- Cost-effectiveness of Monitoring Techniques (J. Wendon).-
Index