Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.
Crit Care. 2013;17 Suppl 1(Suppl 1):S5. doi: 10.1186/cc11503. Epub 2013 Mar 12.
Current hemodynamic monitoring of critically ill patients is mainly focused on monitoring of pressure-derived hemodynamic variables related to systemic circulation. Increasingly, oxygen transport pathways and indicators of the presence of tissue dysoxia are now being considered. In addition to the microcirculatory parameters related to oxygen transport to the tissues, it is becoming increasingly clear that it is also important to gather information regarding the functional activity of cellular and even subcellular structures to gain an integrative evaluation of the severity of disease and the response to therapy. Crucial to these developments is the need to provide continuous measurements of the physiological and pathophysiological state of the patient, in contrast to the intermittent sampling of biomarkers. As technological research and clinical investigations into the monitoring of critically ill patients have progressed, an increasing amount of information is being made available to the clinician at the bedside. This complexity of information requires integration of the variables being monitored, which requires mathematical models based on physiology to reduce the complexity of the information and provide the clinician with a road map to guide therapy and assess the course of recovery. In this paper, we review the state of the art of these developments and speculate on the future, in which we predict a physiological monitoring environment that is able to integrate systemic hemodynamic and oxygen-derived variables with variables that assess the peripheral circulation and microcirculation, extending this real-time monitoring to the functional activity of cells and their constituents. Such a monitoring environment will ideally relate these variables to the functional state of various organ systems because organ function represents the true endpoint for therapeutic support of the critically ill patient.
目前，危重症患者的血流动力学监测主要集中在监测与全身循环相关的压力衍生血流动力学变量。越来越多的人开始关注氧传输途径和组织缺氧存在的指标。除了与组织氧传输相关的微循环参数外，人们越来越清楚地认识到，收集有关细胞甚至亚细胞结构功能活性的信息对于全面评估疾病的严重程度和治疗反应也很重要。这些发展的关键是需要提供对患者生理和病理生理状态的连续测量，而不是对生物标志物进行间歇性采样。随着对危重症患者监测的技术研究和临床研究的进展，越来越多的信息可供床边的临床医生使用。这种信息的复杂性需要对正在监测的变量进行整合，这需要基于生理学的数学模型来降低信息的复杂性，并为临床医生提供指导治疗和评估恢复过程的路线图。在本文中，我们回顾了这些发展的最新进展，并对未来进行了预测，我们预测未来将出现一种能够将全身血流动力学和氧衍生变量与评估外周循环和微循环的变量相结合的生理监测环境，将这种实时监测扩展到细胞及其成分的功能活性。这种监测环境将这些变量与各种器官系统的功能状态联系起来，因为器官功能代表了对危重症患者进行治疗支持的真正终点。
