Less-invasive approaches to perioperative haemodynamic optimization.
OBJECTIVE
A number of less-invasive haemodynamic monitoring devices have been introduced in recent years, largely replacing the pulmonary artery catheter (PAC) as a standard monitoring tool. Apart from tracking cardiac output (CO), these monitors provide additional haemodynamic parameters. The aim of this article is to review the most widely used less-invasive monitoring modalities, their technical characteristics and limitations regarding their clinical performance.


RESULTS
The utilization of CO monitoring in the perioperative setting has been shown to be associated with improved outcomes if integrated into a haemodynamic optimization strategy. These findings provide the basis of recent recommendations for perioperative monitoring.


CONCLUSIONS
An array of monitoring modalities have been introduced that can reliably track CO in the perioperative setting and make the PAC dispensable in most clinical situations. In order to be used safely and efficiently, knowledge regarding the inherent monitoring techniques and their limitations, their clinical validity and the utility of the parameters provided is crucial.
Department of Intensive Care Medicine, St George's Hospital NHS Trust, London, UK.
Martin
M
Geisen
Andrew
A
Rhodes
Maurizio
M
Cecconi
D001794:Blood Pressure; D002407:Catheterization, Swan-Ganz / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D010991:Plethysmography / Q000295:instrumentation; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D013318:Stroke Volume; D014463:Ultrasonography