Heringlake M, Sander M, Treskatsch S, Brandt S, Schmidt C
Klinik für Anästhesiologie und Intensivmedizin, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Justus-Liebig-Universität, Gießen, Deutschland.
Anaesthesist. 2018 Oct;67(10):797-808. doi: 10.1007/s00101-018-0489-3.
Despite broad availability, extended hemodynamic monitoring is used in practice only in the minority of critical care patients. Pathophysiological reasoning suggests that systemic perfusion pressure (and thereby arterial as well as central venous pressure), cardiac stroke volume, and the systemic oxygen balance are key variables in maintaining adequate organ perfusion. In line with these assumptions, several studies support that a goal-directed optimization of these hemodynamic variables leads to a reduction in morbidity and mortality. The appropriate monitoring modality should be selected following echocardiographic evaluation of biventricular function. Ideally, high-risk patients with limited right ventricular function should be monitored with a pulmonary artery catheter. In patients with preserved right ventricular function, transpulmonary thermodilution with special consideration of extravascular lung water seems to be sufficient to guide hemodynamic therapy.
尽管广泛可用，但在实际中，延长血流动力学监测仅用于少数重症监护患者。病理生理推理表明，全身灌注压（从而动脉压以及中心静脉压）、心搏量和全身氧平衡是维持足够器官灌注的关键变量。与这些假设一致，多项研究支持对这些血流动力学变量进行目标导向的优化可降低发病率和死亡率。应在对双心室功能进行超声心动图评估后选择合适的监测方式。理想情况下，右心室功能受限的高危患者应使用肺动脉导管进行监测。对于右心室功能保留的患者，特别考虑血管外肺水的经肺热稀释似乎足以指导血流动力学治疗。
