New Hemodynamic Parameters in Peri-Operative and Critical Care—Challenges in Translation

Abstract

Hemodynamic monitoring technologies are evolving continuously—a large number of bedside monitoring options are becoming available in the clinic. Methods such as echocardiography, electrical bioimpedance, and calibrated/uncalibrated analysis of pulse contours are becoming increasingly common. This is leading to a decline in the use of highly invasive monitoring and allowing for safer, more accurate, and continuous measurements. The new devices mainly aim to monitor the well-known hemodynamic variables (e.g., novel pulse contour, bioreactance methods are aimed at measuring widely-used variables such as blood pressure, cardiac output). Even though hemodynamic monitoring is now safer and more accurate, a number of issues remain due to the limited amount of information available for diagnosis and treatment. Extensive work is being carried out in order to allow for more hemodynamic parameters to be measured in the clinic. In this review, we identify and discuss the main sensing strategies aimed at obtaining a more complete picture of the hemodynamic status of a patient, namely: (i) measurement of the circulatory system response to a defined stimulus; (ii) measurement of the microcirculation; (iii) technologies for assessing dynamic vascular mechanisms; and (iv) machine learning methods. By analyzing these four main research strategies, we aim to convey the key aspects, challenges, and clinical value of measuring novel hemodynamic parameters in critical care.

Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation

“…Although there are many challenges to validating and incorporating new hemodynamic parameters into clinical practice and the decision matrix for hemodynamic instability, they show great promise at measuring indices such as fluid responsiveness, autonomic functions, vascular compliance, tissue metabolism, and microcirculatory parameters. 55 Measuring these variables may refine not only the detection of hemodynamic instability but also guide therapeutic interventions.…”

Non‐Invasive Hemodynamic Monitoring System Integrating Spectrometry, Photoplethysmography, and Arterial Pressure Measurement Capabilities

“…The latter two have attracted attention in recent years due to the inherent risk of complications in invasive techniques, but also due to technological development. [1,[3][4][5] There are several non-invasive techniques to measure hemodynamic parameters. These include visual observation of capillary refill time, pressure sensing using a cuff or a tonometer, photoplethysmography (PPG), laser Doppler flowmetry, near-infrared spectroscopy (NIRS), volume clamping, bioimpedance, bioreactance, pulse wave analysis, and pulse wave transit time.…”

“…The latter two have attracted attention in recent years due to the inherent risk of complications in invasive techniques, but also due to technological development. [ 1 , 3 , 4 , 5 ]…”