Romagnoli S, Bevilacqua S, Lazzeri C, Ciappi F, Dini D, Pratesi C, Gensini G F, Romano S M
Heart and Vessels Department, Cardiac and Vascular Anesthesia and Post-Cardiac Surgery Intensive Care Unit Careggi Hospital, Florence, Italy.
HSR Proc Intensive Care Cardiovasc Anesth. 2009;1(2):20-7.
Invasive hemodynamic monitoring is a cornerstone of the care of critically ill and hemodynamically unstable patients in both intensive care units and operating rooms. The assessment of cardiac output by means of the pulmonary artery catheter has been considered the clinical gold standard. Nevertheless, several concerns have been raised regarding its invasiveness, usefulness, and associated complica-tions. These disadvantages have led to the development, during the last years, of a number of less invasive technologies for cardiac output determination. Among them, those based on the analysis of a peripheral arterial waveform have become commonly used. Most Care(®) is a minimally invasive arterial pressure based monitor powered by the Pressure Recording Analytical Method (PRAM), the only algorithm that does not require prior calibration or pre-calculated parameters and which is based of flow. PRAM provides the measurement of the main factors of hemodynamics, such as systemic blood pressures, stroke volume, cardiac output, and vascular resistances. Moreover, dynamic indices of fluid responsiveness are continuously displayed. In the present paper, we reviewed the current literature focusing on advantages and limitations of PRAM.
有创血流动力学监测是重症监护病房和手术室中危重症及血流动力学不稳定患者护理的基石。通过肺动脉导管评估心输出量一直被视为临床金标准。然而，人们对其侵入性、实用性及相关并发症提出了诸多担忧。这些缺点促使在过去几年中开发出了一些侵入性较小的心输出量测定技术。其中，基于外周动脉波形分析的技术已被广泛应用。Most Care(®)是一种基于微创动脉压的监测仪，由压力记录分析方法（PRAM）驱动，这是唯一一种无需预先校准或预计算参数且基于流量的算法。PRAM可测量血流动力学的主要因素，如全身血压、每搏输出量、心输出量和血管阻力。此外，还会持续显示液体反应性的动态指标。在本文中，我们回顾了当前聚焦于PRAM优缺点的文献。
