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Canadian Journal of Cardiology

New Developments in Continuous Hemodynamic Monitoring of the Critically Ill Patient

  • Etienne J. Couture
    Correspondence
    Corresponding Author: Étienne J. Couture, MD, Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 chemin Ste-Foy, Quebec, Quebec G1V 4G5, Canada. Tel. 418 656-8711 Ext.2641.
    Affiliations
    Department of Anesthesiology and Department of Medicine, Division of Intensive Care Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Quebec, Canada
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  • Pascal Laferrière-Langlois
    Affiliations
    Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, Quebec, Canada
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  • André Denault
    Affiliations
    Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Published:January 17, 2023DOI:https://doi.org/10.1016/j.cjca.2023.01.012

      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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