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Arterial waveform analysis in anesthesia and critical care

Montenij, Leon J.; de Waal, Eric E.C.; Buhre, Wolfgang F.

Current Opinion in Anesthesiology: December 2011 - Volume 24 - Issue 6 - p 651–656
doi: 10.1097/ACO.0b013e32834cd2d9
Technology, education, training and information systems: Edited by Wolfgang Buhre

Purpose of review In this review, we describe the basic principles of arterial waveform analysis (AWA) to assess cardiac output (CO) and cardiac preload. The validity of commercially based hemodynamic monitoring systems is discussed, together with their clinical applications and limitations.

Recent findings Currently, three devices (the FloTrac system, PiCCO monitor, and LiDCO system) are available for measurement of AWA-based CO. In addition, dynamic preload parameters such as stroke volume variation (SVV) and pulse pressure variation (PPV) are determined, which may be useful to predict fluid responsiveness in mechanically ventilated patients.

Summary AWA provides a less invasive and easy-to-use alternative for CO measurement. The validity of AWA devices has been verified in a variety of patients and circumstances, but their performance is compromised in the presence of hemodynamic instability, cardiac arrhythmias, or other factors disturbing the arterial pressure waveform. The definitive role of dynamic preload parameters like SVV and PPV is a matter of research. Large trials in which the value of early goal-directed therapy using this technology is studied in relation to outcome are urgently needed.

Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

Correspondence to Leon J. Montenij, MD, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The NetherlandsTel: +318 875 59633; fax: +31302541828; e-mail: l.j.montenij@umcutrecht.nl

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