Limitations in Hemodynamic Monitoring
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Recent studies have demonstrated quite clearly the inadequacies of clinical estimations of cardiac output (CO) and pulmonary artery wedge pressure (PAWP) in critically ill patients. CO measurements are vital for the correct classification of the type of shock and an accurate value of PAWP is vital for restoration of optimal pre-load without exacerbating co-existing acute respiratory failure by producing an excessively high pulmonary capillary pressure (PCP). There has been a vast improvement in the standard of haemodynamic monitoring available for the management of critically ill patients in the last decade but there is no room for complacency, there being several areas where modern techniques are inapplicable or inadequate.