RT Book, Section
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.
SR Print(0)
ID 56630059
T1 Chapter 30. Hemodynamic Monitoring
T2 Anesthesiology, 2e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-178513-6
LK accessanesthesiology.mhmedical.com/content.aspx?aid=56630059
RD 2024/04/20
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.