title: Haemodynamic monitoring using arterial waveform analysis.
abstract: OBJECTIVE
  To describe the theory behind arterial waveform analysis, the different variables that may be obtained using this method, reliability of measurements and their clinical relevance. Areas for future research are identified.
  
  
  RESULTS
  The precision of cardiac output (CO) measurements varies considerably and deteriorates during haemodynamic instability. Significant device-to-device differences exist. Nevertheless, most are sufficiently accurate for tracking changes in CO. Targeted intervention guided by haemodynamic monitoring reduces mortality and morbidity in high-risk surgical patients. Dynamic changes in variables such as systolic pulse variation, pulse pressure variation (PPV) and stroke volume variation (SVV) may be useful for evaluating fluid responsiveness, although important caveats exist. Newer indices such as PPV : SVV ratio may be useful in identifying preload and vasopressor-dependent patients. Peripheral arterial dP/dt has not been validated in critically ill patients and requires further investigation.
  
  
  CONCLUSIONS
  Despite significant limitations in measurement accuracy and inter-device differences, arterial waveform analysis is a potentially useful tool for monitoring the central circulation in critically ill patients. Future studies investigating the effects of haemodynamic management guided by arterial waveform variables in critically ill patients are urgently needed. The evaluation of cardiopulmonary interactions and usefulness of dP/dt are other areas that require further investigation.
authors.affiliation: Department of Anaesthesia and Intensive Care, Hallands Hospital Halmstad, Sweden. michelle.chew@med.lu.se
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Chew
authors.forename: Anders
authors.initials: A
authors.lastname: Åneman
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003422:Critical Care / Q000379:methods*; D006334:Heart Function Tests / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D013318:Stroke Volume / Q000502:physiology*; D014463:Ultrasonography; D014652:Vascular Diseases / Q000175:diagnosis*