Advanced Hemodynamic Monitoring: Principles and Practice in Neurocritical Care

Abstract

Advanced hemodynamic monitoring is necessary for many patients with acute brain and/or spinal cord injury. Optimizing cerebral and systemic physiology requires multi-organ system function monitoring. Hemodynamic manipulations are cardinal among interventions to regulate cerebral perfusion pressure and cerebral blood flow. The pulmonary artery catheter is not any more the sole tool available; less invasive and potentially more accurate methodologies have been developed and employed in the operating room and among diverse critically ill populations. These include transpulmonary thermodilution, arterial pressure pulse contour, and waveform analysis and bedside critical care ultrasound. A thorough understanding of hemodynamics and of the available monitoring modalities is an essential skill for the neurointensivist.

Impact of Clipping versus Coiling on Postoperative Hemodynamics and Pulmonary Edema after Subarachnoid Hemorrhage

“…It is sometimes difficult to evaluate pulmonary edema on X-ray, whereas PiCCO is a useful modality for quantitative evaluation of the status of the lungs [5, 6]. EVLWI was around the upper limit of the normal range throughout the study period, suggesting postoperative accumulation of extravascular lung water even without any abnormal findings on X-ray.…”

“…Second, cardiac function was evaluated using only PiCCO data, and regular echocardiography or electrocardiography evaluations were not performed. Nevertheless, bedside monitoring using PiCCO is a powerful, established tool for the assessment of cardiopulmonary hemodynamics [5–11]. Third, distribution of the aneurysm location was different between patients who undergo clipping and coiling, which could affect cardiopulmonary function [41, 42].…”

“…It is therefore important to develop reliable assessment modalities for close monitoring of the hemodynamic status. As transpulmonary thermodilution (PiCCO Plus; Pulsion Medical Systems, Munich, Germany) can measure important hemodynamic parameters without the need for cardiopulmonary catheterization, it has gained increasing acceptance in many intensive care units [5, 6] and for volume management in patients with SAH [7–12]. …”

Early Intensive Versus Minimally Invasive Approach to Postoperative Hemodynamic Management After Subarachnoid Hemorrhage

“…Continuous CO calibration, global end-diastolic volume, and extravascular lung water measurements were obtained using a PiCCO monitor and triplicate injections of 15-mL boluses of ice-cold saline (<8°C) via the central venous line. 25 Hemodynamic values were indexed to body surface area to obtain the cardiac index (CI; normal range, 3-5 L·min…”

Rapid detection of recurrent intraventricular hemorrhage by ultrasound in a multiple trauma patient who had undergone craniectomy

“…In this multiple trauma patient, IVH happened twice after the craniectomy and was immediately identified by ultrasound. Meanwhile, ultrasound may detect the characteristics of cerebral blood flow, which helps to assess intracranial pressure and cerebral perfusion pressure [4,5]. This highlights the special value of transcranial ultrasound in critically ill patients with craniectomy.…”