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Cardiac output monitoring: how to choose the optimal method for the individual patient

Saugel, Bernda; Vincent, Jean-Louisb

Current Opinion in Critical Care: June 2018 - Volume 24 - Issue 3 - p 165–172
doi: 10.1097/MCC.0000000000000492
CARDIOPULMONARY MONITORING: Edited by Jean-Louis Teboul
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Purpose of review To review the different methods available for the assessment of cardiac output (CO) and describe their specific indications in intensive care and perioperative medicine.

Recent findings In critically ill patients, persistent circulatory shock after initial resuscitation is an indication for the assessment of CO to monitor the response to fluids and vasoactive agents. In patients with circulatory shock associated with right ventricular dysfunction, pulmonary artery hypertension, or acute respiratory distress syndrome, invasive CO monitoring using indicator dilution methods is indicated. Calibrated and uncalibrated pulse wave analysis enable absolute or relative CO changes to be monitored in real-time during the assessment of fluid responsiveness. In patients undergoing open-heart and thoracic aortic surgery, transesophageal echocardiography is recommended. In selected cardiac surgery patients, advanced hemodynamic monitoring using thermodilution methods can be considered. In high-risk noncardiac surgical patients, invasive pulse wave analysis or esophageal Doppler should be used for perioperative hemodynamic management.

Summary Various invasive, minimally invasive, and noninvasive methods to assess CO are available. A profound understanding of the different CO monitoring methods is key to define indications for CO monitoring in the individual critically ill or surgical patient.

aDepartment of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

bDepartment of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

Correspondence to Bernd Saugel, Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Tel: +49 40 7410 18866; e-mail: bernd.saugel@gmx.de, b.saugel@uke.de

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