Department of Anesthesiology and Intensive Care, Emergency County Hospital of Craiova, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Department of Urology, Emergency County Hospital of Craiova, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Medicina (Kaunas). 2024 Nov 17;60(11):1884. doi: 10.3390/medicina60111884.
Advanced hemodynamic monitoring is fundamental in the management of the critically ill. Blood pressure and cardiac function are key markers of cardiovascular system function;, thus, having accurate measurements of these parameters in critically ill patients is essential. Currently, there are various methods available to choose from, as well as a greater understanding of the methods and criteria to be able to compare devices and select the best option for our patients' needs. Cardiac ultrasound and transpulmonary thermodilution help tailor the therapy for a patient's individual needs by putting the results of a thorough hemodynamic assessment into context. Both these hemodynamic monitoring techniques have their advantages, drawbacks and limitations. Cardiac ultrasound is a safe, non-invasive, less expensive, efficient bedside tool for diagnosing, monitoring and guiding critically ill patients' therapy management. It is recommended in the consensus guidelines as the first-choice method, especially when it comes to identifying different types of shock or the various factors involved. Pulse index contour continuous cardiac output (PiCCO) is a minimally invasive hemodynamic monitoring technique, integrating various static and hemodynamic parameters through a combination of trans-cardiopulmonary thermodilution and pulse contour analysis. The PiCCO method provides guidance to fluid and vasoactive therapy in critically ill patients and is also used for intraoperative and postoperative fluid management and monitoring in cardiac surgery. While invasive methods such as PiCCO are recommended for hemodynamic monitoring and can provide accurate information, they are not always necessary and are contraindicated in some cases.
高级血流动力学监测在危重病患者的管理中至关重要。血压和心功能是心血管系统功能的关键标志物；因此，对危重病患者这些参数进行准确测量至关重要。目前，有多种方法可供选择，并且对这些方法和标准有了更深入的了解，以便能够比较设备并为患者的需求选择最佳方案。心脏超声和经肺热稀释法通过将全面血流动力学评估的结果纳入背景，帮助针对患者的个体需求调整治疗方案。这两种血流动力学监测技术都有其优点、缺点和局限性。心脏超声是一种安全、非侵入性、成本较低、高效的床边工具，可用于诊断、监测和指导危重病患者的治疗管理。在共识指南中推荐将其作为首选方法，尤其是在识别不同类型的休克或涉及的各种因素时。脉搏指示连续心输出量（PiCCO）是一种微创血流动力学监测技术，通过心肺热稀释和脉搏轮廓分析的组合，整合各种静态和血流动力学参数。PiCCO 方法为危重病患者的液体和血管活性治疗提供指导，也用于心脏手术的术中及术后液体管理和监测。虽然 PiCCO 等有创方法推荐用于血流动力学监测并能提供准确的信息，但它们并非总是必要的，并且在某些情况下是禁忌的。
