Abstract
Hemodynamic monitoring is a cornerstone in the assessment of patients with circulatory shock. Timely recognition of hemodynamic compromise and proper optimisation 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 noninvasive and minimally invasive technologies, provides 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. These monitoring strategies are reviewed here, along with detailed analysis of their operating mode, particularities, and limitations. The use of artificial intelligence to enhance performance and effectiveness of hemodynamic monitoring is reviewed to apprehend future possibilities.
Résumé
La surveillance hémodynamique est essentielle à l’évaluation des patients qui présentent un choc circulatoire. Le diagnostic rapide d’un déséquilibre hémodynamique et une optimisation appropriée sont nécessaires pour assurer une perfusion adéquate des tissus et préserver la fonction rénale, hépatique, abdominale et cérébrale. La surveillance hémodynamique a évolué considérablement depuis la mise au point du cathéter artériel pulmonaire il y a plus de 50 ans. L’échocardiographie au chevet du patient, lorsqu’elle est combinée à des techniques non invasives ou minimalement invasives, permet de surveiller et de quantifier le débit cardiaque afin d’être en mesure d’intervenir rapidement et d’améliorer la prise en charge hémodynamique en contexte de soins aigus. Les technologies couramment utilisées comprennent l’analyse non invasive de l’onde de pouls, le temps de transit de l’onde de pouls, la bioimpédance et la bioréactance thoraciques, le doppler œsophagien, l’analyse minimalement invasive de l’onde de pouls, la thermodilution transpulmonaire et le cathéter artériel pulmonaire. Ces stratégies de surveillance sont passées en revue dans cet article, et une analyse détaillée de leur mode de fonctionnement, de leurs particularités et de leurs limites est présentée. Le recours à l’intelligence artificielle pour améliorer les résultats et l’efficacité de la surveillance hémodynamique est également abordé dans un souci d’exploration des possibilités qu’offre cette technologie.
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Article info
Publication history
Published online: January 17, 2023
Accepted: January 12, 2023
Received: September 14, 2022
Footnotes
See page 440 for disclosure information.
Identification
Copyright
© 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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