RT Book, Section A1 Bar-Yosef, Shahar A1 Schroeder, Rebecca A. A1 Mark, Jonathan B. A2 Longnecker, David E. A2 Mackey, Sean C. A2 Newman, Mark F. A2 Sandberg, Warren S. A2 Zapol, Warren M. SR Print(0) ID 1144115574 T1 Hemodynamic Monitoring T2 Anesthesiology, 3e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9780071848817 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144115574 RD 2024/10/09 AB KEY POINTSWhen measuring invasive hemodynamic pressures, attention should be paid 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, such as central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP), is confounded by many variables, notably changes in ventricular compliance, cardiac 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, particularly in patients with severe pulmonary hypertension.There are no accepted “gold standards” for cardiac output measurement. It is more clinically useful to follow trends in cardiac output rather than consider absolute values.Functional indices based on respiratory variation in hemodynamic parameters are better predictors of fluid responsiveness compared to static filling pressures or volumetric indices.Metabolic indices, such as lactate, base excess, and venous oxygen saturation, should be included in the evaluation of the hemodynamic status of the critically ill patient.Preemptive goal-directed therapy, aimed at optimization of volume status and cardiac output in the intraoperative period, has been found to decrease mortality in very high-risk surgical patients and decrease morbidity in high- to moderate-risk patients.