Clinical review: Update on hemodynamic monitoring--a consensus of 16

Jean-Louis Vincent, Andrew Rhodes, Azriel Perel, Greg S Martin, Giorgio Della Rocca, Benoit Vallet, Michael R Pinsky, Christoph K Hofer, Jean-Louis Teboul, Willem-Pieter de Boode, Sabino Scolletta, Antoine Vieillard-Baron, Daniel De Backer, Keith R Walley, Marco Maggiorini, Mervyn Singer, Jean-Louis Vincent, Andrew Rhodes, Azriel Perel, Greg S Martin, Giorgio Della Rocca, Benoit Vallet, Michael R Pinsky, Christoph K Hofer, Jean-Louis Teboul, Willem-Pieter de Boode, Sabino Scolletta, Antoine Vieillard-Baron, Daniel De Backer, Keith R Walley, Marco Maggiorini, Mervyn Singer

Abstract

Hemodynamic monitoring plays a fundamental role in the management of acutely ill patients. With increased concerns about the use of invasive techniques, notably the pulmonary artery catheter, to measure cardiac output, recent years have seen an influx of new, less-invasive means of measuring hemodynamic variables, leaving the clinician somewhat bewildered as to which technique, if any, is best and which he/she should use. In this consensus paper, we try to provide some clarification, offering an objective review of the available monitoring systems, including their specific advantages and limitations, and highlighting some key principles underlying hemodynamic monitoring in critically ill patients.

Figures

Figure 1
Figure 1
Diagnostic algorithm based on use of echocardiography. CVP, central venous pressure; RV, right ventricular.
Figure 2
Figure 2
Factors influencing the interpretation of cardiac output (CO). EKG, electrocardiogram; NIRS, near-infrared spectral imaging; OPS, orthogonal polarization spectral imaging; PAOP, pulmonary artery occlusion pressure; PAP, pulmonary artery pressure; PgCO2, gastric intramucosal carbon dioxide partial pressure; RAP, right atrial pressure; SvO2, mixed venous oxygen saturation.
Figure 3
Figure 3
Diagnostic algorithm based on mixed venous oxygen saturation (SvO2) and cardiac output. VO2, oxygen consumption.

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