ABSTRACT Unstructured
Hemodynamic monitoring is a cornerstone in the assessment of patients with circulatory
shock. Timely recognition of hemodynamic compromise and proper optimization is essential
to ensure adequate tissue perfusion and maintain renal, hepatic, abdominal and cerebral
functions. Hemodynamic monitoring has significantly evolved since the first inception
of the pulmonary artery catheter more than 50 years ago. Bedside echocardiography,
when combined with non-invasive and minimally invasive technologies, represent tools
to monitor and quantify the cardiac output to promptly react and improve hemodynamic
management in an acute care setting. Commonly used technologies include noninvasive
pulse wave analysis, pulse wave transit time, thoracic bioimpedance and bioreactance,
esophageal Doppler, minimally invasive pulse wave analysis, transpulmonary thermodilution
and pulmonary artery catheter. In this review, these monitoring strategies will be
reviewed, along with detailed analysis of their operating mode, their particularities,
and their limitations. The use of artificial intelligence to enhance performance and
effectiveness of hemodynamic monitoring will be reviewed to apprehend future possibilities.
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Article info
Publication history
Accepted:
January 12,
2023
Received in revised form:
January 11,
2023
Received:
September 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure
Dr. Denault is a speaker and consultant for CAE Healthcare and speaker for Edwards and Masimo. He received a research grant from Edwards (2019). He is supported by the Montreal Heart Institute Foundation and Richard I. Kaufman Endowment Fund in Anesthesia and Critical Care.
Dr. Couture does not have any conflict of interest or financial disclosure to declare.
Dr. Laferrière-Langlois does not have any conflict of interest or financial disclosure to declare.
The funding sources had no role in the design or writing of the manuscript as no funding was necessary by the authors for the elaboration of this article.
Brief Summary
Hemodynamic monitoring is a cornerstone to the recognition and assessment of circulatory shock, and appreciation of the effectiveness of fluid, inotropic and vasoactive therapies. Bedside monitoring technologies, including echocardiography, noninvasive pulse wave analysis, pulse wave transit time, thoracic bioimpedance and bioreactance, esophageal Doppler, minimally invasive pulse wave analysis, transpulmonary thermodilution, pulmonary artery catheter and their optimization by artificial intelligence will all be reviewed.
Glossary: AI: artificial intelligence; APCO: Arterial Pressure-based Cardiac Output; AUROC: area under the receiving operator characteristics; CCO: continuous cardiac output; CO: cardiac output; dP/dt: change in systolic pressure over time; ECG: electrocardiogram; ECMO: extracorporeal membrane oxygenation; EVLW: extravascular lung water; FAST: Focused Assessment with Sonography in Trauma; FATE: Focus Assessed Transthoracic Echocardiography; FCU: Focused Cardiac Ultrasound; FVF: femoral venous flow; GEDV: global end-diastolic blood volume; HEART: Hemodynamic Echocardiography Assessment in Real Time; HPI: Hypotension Prediction Index; HVF: hepatic venous flow; ICU: intensive care unit; IRVF: interlobar renal venous flow; MAP: mean arterial pressure; PAC: pulmonary artery catheter; PVF: portal venous flow; PVPI: pulmonary vascular permeability index; RAP: right atrial pressure; RCT: randomized controlled trial; RUSH: Rapid Ultrasound for Shock and Hypotension; RV: right ventricular; RVEF: right ventricular ejection fraction; RVOTO: right ventricular outflow tract obstruction; RVP: right ventricular pressure; SV: stroke volume; SvO2: mixed venous oxygen saturation; TWA: time-weighted average; VTI: velocity time integral
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
