Functional Hemodynamic Monitoring

doi:2012.2.1.25

J Acute Care Surg > Volume 2(1); 2012 > Article

Review Article

Journal of Surgical Critical Care 2012;2(1):25-28.
DOI: https://doi.org/10.17479/jacs.2012.2.1.25 Published online April 30, 2012.

Functional Hemodynamic Monitoring

기능적 혈역학적 감시

홍석경

Division of Trauma and Surgical Critical Care, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Abstract

Hemodynamic monitoring is a cornerstone of critical care for the hemodynamically unstable patients. The single absolute monitoring value is 'Static hemodynamic monitoring'. But its utility of absolute value is questionable. 'Functional hemodynamic monitoring' performed to evaluate the effect of treatment. First, the primary goal of volume challenge is preload responsiveness. Challenge a relatively small intravascular volume rapidly and observe the subsequent change of in terms of blood pressure, pulse, and cardiac output. In high risk patient, passive Leg raising maneuver can be replaced. The transient hemodynamic effect of passive leg raising on left ventricular stroke volume. PLR is considered as a 'reversible fluid challenge' which allow for rapid and reversible preload challenge without additional fluid challenge. On second, the change of central venous pressure (CVP) with respiration can be used. The hemodynamic effect of the respiration is dependent on the change of intrathoracic pressure. With spontaneous respiration, venous return increases in association with the decrease in intrathoracic pressure. CVP will decrease with intrathoracic pressure decrease. Last, respiration will induce a cyclic variation in cardiac output and arterial pulse pressure in hypovolemic patients. To identify cardiac output change, the stroke volume variation (SVV), pulse pressure variation (PPV), and systolic pressure variation (SPV) can be used. Hemo-dynamic monitoring is of utmost importance in the management of critically ill patients. We should try to find out individualized adequate hemodynamic goal. The best monitor is the caregiver who understands the monitoring equipment, alarm and resulting data. (J Surg Crit Care 2012;2:25-28)

Key Words: Hemodynamic monitoring, Cardiac output, Stroke volume, Central venous pres-sure, Fluid, Stroke volume