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2014 ; 20
(3
): 288-93
Nephropedia Template TP
Curr Opin Crit Care
2014[Jun]; 20
(3
): 288-93
PMID24722057
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PURPOSE OF REVIEW: Functional haemodynamic monitoring is the assessment of the
dynamic interactions of haemodynamic variables in response to a defined
perturbation. RECENT FINDINGS: Fluid responsiveness can be predicted during
positive pressure breathing by variations in venous return or left ventricular
output using numerous surrogate markers, such as arterial pulse pressure
variation (PPV), left ventricular stroke volume variation (SVV), aortic velocity
variation, inferior and superior vena cavae diameter changes and pulse oximeter
pleth signal variability. Similarly, dynamic changes in cardiac output to a
passive leg raising manoeuvre can be used in any patient and measured invasively
or noninvasively. However, volume responsiveness, though important, reflects only
part of the overall spectrum of functional physiological variables that can be
measured to define physiologic state and monitor response to therapy. The ratio
of PPV to SVV defines central arterial elastance and can be used to identify
those hypotensive patients who will not increase their blood pressure in response
to a fluid challenge despite increasing cardiac output. Dynamic tissue O2
saturation (StO2) responses to complete stop flow conditions, as can be created
by measuring hand StO2 and occluding flow with a blood pressure cuff, assesses
cardiovascular sufficiency and micro-circulatory blood flow distribution. They
can be used to identify those ventilator-dependent individuals who will fail a
spontaneous breathing trial or trauma patients in need of life-saving
interventions. SUMMARY: Functional haemodynamic monitoring approaches are
increasing in numbers, conditions in which they are useful and resuscitation
protocol applications. This is a rapidly evolving field whose pluripotential is
just now being realized.
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