Arterial waveform analysis in anesthesia and critical care.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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. l.j.montenij@umcutrecht.nl
Leon J
LJ
Montenij
Eric E C
EE
de Waal
Wolfgang F
WF
Buhre
D000758:Anesthesia; D001794:Blood Pressure; D002302:Cardiac Output; D003422:Critical Care / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods*; D013318:Stroke Volume