Monitoring high-risk patients: minimally invasive and non-invasive possibilities

Perioperative Fluid Management in the Enhanced Recovery after Surgery (ERAS) Pathway

“…While many of these technologies have not been utilized in studies directly measuring the impact of fluid management within ERAS protocols, they represent advancements that may allow GDFT to be used more frequently due to their less invasive nature. 54,55 Most studies involving GDFT within the context of ERAS have relied on transesophageal Doppler. The transesophageal Doppler makes use of the Doppler principle to measure the velocity of blood flow at the level of the descending aorta.…”

“…56 One of the most commonly used devices (CardioQ; Deltex Medical, Chichester, UK) uses a nomogram based on patients' age, height, weight, and gender. 54,55 Several commercial devices have used arterial pressure waveform to provide continuous cardiac output measurement (FloTrac/Vigileo, Edwards Lifesciences, Irvine, CA; PiCCO, Pulsion Medical Systems, Munich, Germany; LiDCOrapid, LiDCO Group, plc., London, UK). 57,58 These devices use technology that expands on observations by Erlanger and Hooker in 1904 that stroke volume and pulse pressure are directly proportional.…”

Time to Change the Objectives Hemodynamic to Guide the Perioperative Fluid Management?

“…The implementation in clinical practice of these hemodynamic parameters would not have been possible without the technological developments in monitoring: from the invasiveness of catheter Pulmonary Artery with iatrogenic this may lead, to the current monitoring minimally invasive such as monitors based on arterial pressure waveform and esophageal Doppler, and even non-invasive monitors as the finger-cuff-based technologies [15].…”

“…The values obtained with the arterial pressure waveform are derived values, this subtracts reliability that and makes these monitors are not useful in high-risk patients such as severe cardiac patients and as occurs in critically ill patients. It should be remembered that under theses circumstances, the more higher reliability is required and this leads to greater invasiveness [10,14,15].…”

Perioperative goal-directed haemodynamic therapy based on flow parameters: a concept in evolution

“…Although intraoperative oesophageal Doppler monitoring (ODM) of SV and cardiac output has been widely used for more than 20 yr, more recently there has been rapid development and marketing of other minimally and noninvasive devices designed to measure cardiac output, without the risk associated with PAC insertion. Multiple reviews have recently been published describing technical aspects of existing technologies along with clinical application, [22][23][24] and more devices are in development. An important feature of many new methods is the ability, such as ODM, to continuously measure SV, a major improvement over bolus thermodilution that provides only intermittent measurement of cardiac output from which SV is derived.…”