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Haemodynamic monitoring using arterial waveform analysis

Chew, Michelle S.a,b; Åneman, Andersc,d

Current Opinion in Critical Care: June 2013 - Volume 19 - Issue 3 - p 234–241
doi: 10.1097/MCC.0b013e32836091ae
CARDIOPULMONARY MONITORING: Edited by Anthony S. McLean

Purpose of review To describe the theory behind arterial waveform analysis, the different variables that may be obtained using this method, reliability of measurements and their clinical relevance. Areas for future research are identified.

Recent findings The precision of cardiac output (CO) measurements varies considerably and deteriorates during haemodynamic instability. Significant device-to-device differences exist. Nevertheless, most are sufficiently accurate for tracking changes in CO. Targeted intervention guided by haemodynamic monitoring reduces mortality and morbidity in high-risk surgical patients. Dynamic changes in variables such as systolic pulse variation, pulse pressure variation (PPV) and stroke volume variation (SVV) may be useful for evaluating fluid responsiveness, although important caveats exist. Newer indices such as PPV : SVV ratio may be useful in identifying preload and vasopressor-dependent patients. Peripheral arterial dP/dt has not been validated in critically ill patients and requires further investigation.

Summary Despite significant limitations in measurement accuracy and inter-device differences, arterial waveform analysis is a potentially useful tool for monitoring the central circulation in critically ill patients. Future studies investigating the effects of haemodynamic management guided by arterial waveform variables in critically ill patients are urgently needed. The evaluation of cardiopulmonary interactions and usefulness of dP/dt are other areas that require further investigation.

aDepartment of Anaesthesia and Intensive Care, Hallands Hospital Halmstad

bInstitute of Clinical Sciences Malmö, Lund University, Sweden

cIntensive Care Unit, Liverpool Hospital, Liverpool BC, New South Wales

dUniversity of New South Wales, Sydney, Australia

Correspondence to Michelle S. Chew, Institute of Clinical Sciences Malmö, Lund University, S-20502, Sweden. Tel: +46 35 147809; e-mail: michelle.chew@med.lu.se

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins