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Hemodynamic Monitoring in Critical Care

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Diet and Nutrition in Critical Care

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Abstract

In the critically ill patient, hemodynamic monitoring is vital for determining a patient’s volume status and can assist a clinician in determining potential therapeutic options, including intravenous fluid resuscitation or a fluid challenge. Incorrect determination of volume status or an ill-advised fluid bolus can have grave consequences. Moreover, there are a number of clinical scenarios where volume status is difficult to determine. As such, a myriad of tools have been developed to assist a clinician in assessing volume status or responsiveness to a fluid challenge, with the ultimate objective of optimizing tissues oxygenation and organ perfusion.

Hemodynamic monitoring tools rely on the tenets of basic human cardiovascular physiology, which is characterized by the relationship between cardiac output, systemic vascular resistance, and mean arterial pressure. Because measuring stroke volume in real time is difficult, determining cardiac output (SV × heart rate) is the also elusive. Unfortunately for the clinician, cardiac output is also the most relevant to assessing volume status. Newer dynamic measures, which rely on real-time measurements of certain physiological parameters to calculate volume responsiveness, have replaced earlier static measures of volume status, including pulmonary artery occlusion pressure, central venous pressure, and left ventricular end-diastolic area. The static measurements are still widely used in many ICUs and can be determined via transduction of a pulmonary artery catheter or internal jugular or subclavian central venous catheter. The newer techniques rely on analysis of fluctuations in certain vital signs during respiratory variation (as in the case with pulse contour analysis and inferior vena cava diameter variation measurement) or direct measurement of blood volume or flow through the aorta (as in the case with pulmonary artery catheter thermodilution, transpulmonary thermodilution, thoracic electrical bioimpedance, and esophageal Doppler analysis), to determine cardiac output. Data on the benefit of one method of hemodynamic monitoring over another is largely mixed, and certain techniques may be more accurate or feasible in specific clinical scenarios.

Ultimately, sound clinical judgment, proper interpretation of measurements, and appropriate therapeutic responses to analyses are the most important aspects of hemodynamic monitoring. Other facets of critical care, such as surgical management, mechanical ventilation strategies, renal therapies, and nutrition, are all related to hemodynamics and are dictated, to some extent, by volume status. Within nutrition, whether to feed a hemodynamically unstable patient remains controversial, as has the use of immune modulating nutritional therapies in patients who are in various states of shock.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

CO:

Cardiac output

CVP:

Central venous pressure

ED:

Esophageal Doppler

IVCd:

Inferior vena cava diameter

LVEDA:

Left ventricular end-diastolic area

MAP:

Mean arterial pressure

PA:

Pulmonary artery

PCA:

Pulse contour analysis

PEEP:

Positive end-expiratory pressure

PLR:

Passive leg raise

POP:

Pulse oximetry plethysmographic waveform

PPV:

Pulse pressure variation

SPV:

Systolic pressure variation

SV:

Stroke volume

SVR:

Systemic vascular resistance

SVV:

Stroke volume variation

TD:

Thermodilution

TEB:

Thoracic electrical bioimpedance

TPTD:

Transpulmonary thermodilution

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Author information

Authors and Affiliations

  1. Department of Medicine, Medical Critical Care Services (MCCS), Inova Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA, 22042, USA

    Laurence Busse

  2. Department of Anesthesia and Critical Care Medicine, Department of Medicine, Division of Renal Disease and Hypertension, George Washington University Medical Center, 900 23rd Street NW Suite G-105, Washington, DC, 20037, USA

    Danielle Davison & Lakhmir Chawla

  3. Program Manager, Critical Care Service, Inova Fairfax Medical Campus, 3300 Gallows Rd, Falls Church, VA, 22042, USA

    Priscilla Jang

Authors
  1. Laurence Busse
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  2. Danielle Davison
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  3. Lakhmir Chawla
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  4. Priscilla Jang
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Corresponding author

Correspondence to Laurence Busse .

Editor information

Editors and Affiliations

  1. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  2. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  3. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  4. Department of Nutrition and Dietetics, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Victor R. Preedy

  5. Department of Biomedical Sciences, Faculty of Science & Technology, University of Westminster, London, UK

    Vinood B. Patel

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Busse, L., Davison, D., Chawla, L., Jang, P. (2015). Hemodynamic Monitoring in Critical Care. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7836-2_36

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