TY - CHAP M1 - Book, Section TI - Chapter 30. Hemodynamic Monitoring A1 - Bar-Yosef, Shahar A1 - Schroeder, Rebecca A. A1 - Mark, Jonathan B. A2 - Longnecker, David E. A2 - Brown, David L. A2 - Newman, Mark F. A2 - Zapol, Warren M. PY - 2012 T2 - Anesthesiology, 2e AB - When interpreting invasive hemodynamic pressures, consideration should be given to technical aspects including the zero reference level, dynamic response of the monitoring system, and effects of changes in intrathoracic pressures.Much diagnostic information can be gleaned from the analog waveform of directly measured pressures, both arterial blood pressure and cardiac filling pressures.Interpretation of filling pressures like central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) is confounded by many variables, notably changes in ventricular compliance, valvular abnormalities, and positive pressure ventilation.Pulmonary artery catheter monitoring without a structured therapeutic intervention protocol has generally not been found to be beneficial in most perioperative and critical care settings. It might still be justified in very high-risk patients or in critically ill patients who do not respond to empiric therapy.There are no accepted gold standards for cardiac output measurement. It is more clinically useful to follow trends in cardiac output rather than considering absolute values.Functional indices based on respiratory variation in hemodynamic parameters are better predictors of fluid responsiveness compared with static filling pressures or volumetric indices.Metabolic indices like lactate, base excess, and venous oxygen saturation should be included in the hemodynamic assessment of the critically ill patient.Preemptive goal directed therapy, aimed at optimization of hemodynamic goals before and during surgery, has been found to decrease mortality in high-risk surgical patients and decrease morbidity in moderate-risk patients. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=56630059 ER -