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Hemodynamic Monitoring in Intensive Care Unit:Where we are Today?


  • Department of Cardiac Anaesthesia, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India


A significant alteration of attitude towards hemodynamic monitoring in clinical setting happened during the last half of 1970.This occurred as a consequence towards the relative insensitivity and unresponsiveness of clinical methods to diagnose the rapid physiologic changes, especially in the critical care settings. During the 1980s the principles of hemodynamic monitoring allowed the basic physiological measurements to be applied in a consistent and meaningful manner for the management of a cardiovascular aspect of critical illness. The first paradigm shift in the hemodynamic monitoring can be traced back to the development of cardiac catheterization by Werner Forssmann in 19291. The idea of advanced hemodynamic monitoring was developed by HJC Swan, who developed balloon-tipped Swan-Ganz catheter from his observation of motion of sailboats on the Santa-Monica Bay in 19672. For more than 30 years, the pulmonary catheterization method has generally been accepted and is still the clinical standard to which the other methods are compared. Recent advances in technology have led to the development of minimally invasive (Flo-tracVigileo and transesophageal echocardiography) and noninvasive methods (impedance cardiography) for hemodynamic monitoring in critical care unit. The current narrative review is an attempt to highlight the present perspectives in hemodynamic monitoring in the Intensive Care Unit (ICU).


Hemodynamic Monitoring, Intensive Care Unit, Indications.

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  • Berry D. Pioneers in cardiology. Werner Forssman–sowing the seeds for selective cardiac catheterisation procedures in the twentieth century. European Heart Journal 2009;30: 1296–7.
  • Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloontipped catheter. N Engl J Med 1970 27;283:447–51.
  • Partridge BL. Use of pulse oximetry as a noninvasive indicator of intravascular volume status. J Clin Monit 1987;3:363–8.
  • Severinghaus JW, Honda Y. History of bood gas analysis. VII Pulse oximetry. J Clin Monit 1987;3:135–8.
  • Ahrens T, Schallom L, Bettorf K, Ellner S, O’Mara VHG, Ludwig J, et al. End tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care 2001;10:391–8.
  • Grmec S, Klemen P. Does the end tidal carbon dioxide (EtCO2) concentration have prognostic value during out-of-hospital arrest? Eur J Emergency Med 2001;8:263–9.
  • Falk JL, Rackow EC, Well MH. End tidal carbon dioxide concentration during cardiopulmonary resuscitation. N Engl J Med 1988;318:607–11.
  • Wayne MA, Levine RL, Miller CC. Use of end tidal carbon dioxide to predict outcome in prehospital cardiac arrest. Ann Emerg Med 1995;25:762–7.
  • Weiss BM, Gattiker RI. Complications during and following radial artery cannulation: A prospective study. Intensive Care Med 12:424–8. Swan HJ. Second annual SCCM lecture. The role of hemodynamic monitoring in the management of the critically ill. Crit Care Med 1975;3:83–9.
  • Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Annals of Intensive Care 2011:1:1.
  • Martin UJ, Diaz–Abad M, Krachman SL. Hemodynamic monitoring. In: Criner G, Rodger B, D’Alonza G, editors. Critical Care Study Guide. Test and Review. 2nd ed. New York: Springer; 2010. p. 51–76.
  • Perez AC, Eulmesekian PG, Minces PG, Schnitzler EJ. Adequate agreement between venous oxygen saturation in right atrium and pulmonary artery in critically ill children. Pediatr Crit Care Med 2009;10:76–9.
  • Dueck MH, Klimek M, Appenrodt S, Weigand C, Boerner U. Trends but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions. Anesthesiology 2005;103:249–57.
  • Delligner RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med 2008;34:17–60.
  • Rivers EP, Martin GB, Smithline H, Rady MY, Schultz CH, Goetting MG, et al. The clinical implications of continuous central venous oxygen saturation during human CPR. Ann Emerg Med 1992;21:1094–101.
  • Shah MR, Hasselblad V, Stevenson LW, Binanay C, O’Connor CM, Sopko G, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 2005;294:1664–70.
  • Huber W, Phillip V, Höllthaler J, Schultheiss C, Saugel B, Schmid RM. Femoral indicator injection for transpulmonary thermodilution using the EV1000/VolumeView(®): do the same criteria apply as for the PiCCO(®)? J Zhejiang Univ Sci B 2016;17:561–7.
  • Xiao W, Duan Q, Zhao L, Wang F, Wang T. Goal directed fluid therapy with LiDCO (rapid) in a parturient with WPW syndrome and cardiac dysfunction undergoing emergent cesarean section. Chin Med J 2014;127:2719–20.
  • Ye J, Jiang Y, Luo S, Wang F, Zhang X. Development of cardiac output monitoring system based on thermodilution method. Zhongguo Yi Liao Qi Xie Za Zhi 2014;3:337–40.
  • Meheta Y, Arora D. Newer methods of cardiac output monitoring. World J Cardiol 2014;26(6):1022–9.
  • Sivak ED, Wiedemann HP. Clinical measurement of extravascular lung water. Critical Care Clin North Am 1986;2:511–26.
  • Bakker J, Coffernils M, Leon M, Gris O, Vincent JL. Blood lactate levels are superior to oxygen derived variables in predicting outcome in human septic shock. Chest 1994:956–62
  • Russel JA. Gastric tonometry: does it works? Intensive Care Med1994;23:3–6.
  • Wahr JA, Temper KK, Samra S, Delpy DT. Near infrared spectroscopy: theory and applications. J Cardiothorac Vasc Anaesth 1996;11:406–18.
  • Valadka AB, Gopinath SP, Contant CF, Uzura M, Rohertson CS. Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med 1998;26:1576–81.