Ulteriori informazioni
Hemodynamic monitoring is one of the major diagnostic tools available in the acute care setting to diagnose cardiovascular insufficiency and monitor changes over time in response to interventions. However, the rationale and efficacy of hemodynamic monitoring to affect outcome has come into question. We now have increasing evidence that outcome from critical illness can be improved by focused resuscitation based on existing hemodynamic monitoring, whereas non-specific aggressive resuscitation impairs survival. Thus, this book frames hemodynamic monitoring into a functional perspective wherein hemodynamic variables and physiology interact to derive performance and physiological reserve estimates that themselves drive treatment. This philosophy, as well as the limitations and applications of common and evolving hemodynamic measures and their focused use in the care of critically ill patients are discussed, relevant to one underlying truth: No monitoring device, no matter how simple or sophisticated, will improve patient-centered outcomes useless coupled to a treatment which, itself, improves outcome.
Sommario
Functional Hemodynamic Monitoring: Foundations and Future.- Therapeutic goals.- Defining Hemodynamic Instability.- Determinants of Blood Flow and Organ Perfusion.- Determining Effectiveness of Regional Perfusion.- Microcirculatory and Mitochondrial Distress Syndrome (MMDS): A New Look at Sepsis.- 'Adequate' Hemodynamics: A Question of Time?.- Limits and Applications of Hemodynamic Monitoring.- Arterial Pressure: A Personal View.- Central Venous Pressure: Uses and Limitations.- Pulmonary Artery Occlusion Pressure: Measurement, Significance, and Clinical Uses.- Cardiac Output by Thermodilution and Arterial Pulse Contour Techniques.- Clinical Value of Intrathoracic Volumes from Transpulmonary Indicator Dilution.- Methodology and Value of Assessing Extravascular Lung Water.- Arterial Pulse Contour Analysis: Applicability to Clinical Routine.- Arterial Pulse Power Analysis: The LiDCO? plus System.- Esophageal Doppler monitoring.- Splanchnic Blood Flow.- Measurement of Oxygen Derived Variables and Cardiac Performance.- Microcirculatory Blood Flow: Videomicroscopy.- Mixed Venous Oxygen Saturation (SvO2).- Central Venous Oxygen Saturation (ScvO2).- DO2/VO2 relationships.- Cardiac Preload Evaluation Using Echocardiographic Techniques.- Right Ventricular End-Diastolic Volume.- Assessment of Fluid Responsiveness.- Fluid Therapy of Tissue Hypoperfusion.- The Use of Central Venous Pressure in Critically Ill Patients.- Arterial Pressure Variation during Positive-pressure Ventilation.- Arterial Pulse Pressure Variation During Positive Pressure Ventilation and Passive Leg Raising.- Development of Treatment Algorithms.- Standardization of Care by Defining Endpoints of Resuscitation.- Protocolized Cardiovascular Management Based on Ventricular-arterial Coupling.- Cost Effectivenessof Monitoring Techniques.
