Effective hemodynamic monitoring

• Type of Material: Article
• Authors: Michael R. Pinsky, University of Pittsburgh; Maurizio Cecconi, Humanitas University; Michelle S. Chew, Linkoping University; Daniel De Backer, Universite Libre de Bruxelles; Ivor Douglas, University of Colorado; Mark Edwards, University of Southampton; Olfa Hamzaoui, University Hospitals of Reims; Glenn Hernandez, Pontificia Universidad Católica de Chile; Gregory Martin, Emory University; Xavier Monnet, Universite Paris Saclay; Bernd Saugel, University Medical Center Hamburg-Eppendorf; Thomas W. L. Scheeren, University Medical Center Groningen; Jean-Louis Teboul, Universite Paris Saclay; Jean-Louis Vincent, Universite Libre de Bruxelles
• Language: English
• Date: 2022-09-28
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13054-022-04173-z
• Title of Journal or Parent Work: CRITICAL CARE
• Volume: 26
• Issue: 1
• Start Page: 294
• End Page: 294
• Grant/Funding Information: Michael R. Pinsky, MD: NIH HL14191 &, NR013912. MRP was funded by NHLBI (Grant No. HL141916).
• Keywords: PULSE PRESSURE; INTENSIVE-CARE; RANDOMIZED CLINICAL-TRIAL; RESPIRATORY CHANGES; General & Internal Medicine; NONCARDIAC SURGERY; ABDOMINAL-SURGERY; DYNAMIC ARTERIAL ELASTANCE; HIGH-RISK PATIENTS; Science & Technology; Life Sciences & Biomedicine; FLUID RESPONSIVENESS; Critical Care Medicine; PERIOPERATIVE INCREASE
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

Hemodynamic monitoring is the centerpiece of patient monitoring in acute care settings. Its effectiveness in terms of improved patient outcomes is difficult to quantify. This review focused on effectiveness of monitoring-linked resuscitation strategies from: (1) process-specific monitoring that allows for non-specific prevention of new onset cardiovascular insufficiency (CVI) in perioperative care. Such goal-directed therapy is associated with decreased perioperative complications and length of stay in high-risk surgery patients. (2) Patient-specific personalized resuscitation approaches for CVI. These approaches including dynamic measures to define volume responsiveness and vasomotor tone, limiting less fluid administration and vasopressor duration, reduced length of care. (3) Hemodynamic monitoring to predict future CVI using machine learning approaches. These approaches presently focus on predicting hypotension. Future clinical trials assessing hemodynamic monitoring need to focus on process-specific monitoring based on modifying therapeutic interventions known to improve patient-centered outcomes.