Introduction to Hemodynamic Monitoring

Abstract

Accurate assessment of hemodynamic status is vital for making correct decisions in the acute care environment. Clinical examination and the monitoring of vital signs alone, though being of utmost importance, may often be inadequate for this purpose. Since management decisions, when based on inaccurate clinical assessment, may be detrimental to patients, additional monitoring of various physiological variables may be of help in better guiding and titrating therapy. The selection and application of specific monitoring modalities and the correct interpretation of the monitored variables present however a considerable challenge. Common pitfalls of hemodynamic monitoring include the underestimation of the limitations and confounding factors of hemodynamic variables, overreliance on single numerical values, and the frequent inherent inaccuracies of the monitoring process itself. Since outcome is determined mainly by our clinical decisions and not by the monitor we use, the ensuing general lack of evidence about the impact of hemodynamic monitoring on patient outcome presents another significant obstacle in choosing the right monitor for the right patient. A thorough understanding of the underlying physiology and of the limitations of hemodynamic variables, continuity of measurement, a multiparametric approach, and more reliable decision-making strategies are some of the means that will allow us to correctly combine both established and newer monitoring technologies for the benefit of our patients.