Vital Times 2020 - 64

ENGINEERING AND TECHNOLOGY

Non-Invasive Hemodynamic
Monitoring Technology in the
Perioperative Setting
Annie Wang, MD, Uoo Ram Kim, MD, Melissa McCabe, MD

A

s hemodynamic monitoring has evolved
from invasive techniques to newer noninvasive devices, there has been remarkable
development in improving the integration of clinical
and physiologic data to support clinical decisionmaking in various healthcare settings. With this new
paradigm, there has been a shift from monitoring
static parameters towards dynamic hemodynamic
measurements. Despite these advancements, there
remains a gap between clinical research and clinical
practice.1
Blood pressure and cardiac output (CO) are among the
most important hemodynamic variables. Reliable and
accurate methods for measuring these variables are
vital to reducing perioperative morbidity and mortality,
especially for critically ill patients undergoing highrisk surgery.2 Institutional preferences and protocols
for goal-directed therapy often influence the modality
for hemodynamic assessment, as does the clinical
location where assessment occurs.1,3
Traditional methods for assessing blood pressure and
CO include both non-invasive and invasive devices.
The non-invasive blood pressure (NIBP) cuff is widely
available and easy to use; however, measurements
can be unreliable. Improper cuff size and device
calibration errors may yield an inaccurate assessment
of cardiac function.4,5 Direct arterial cannulation is a
more reliable alternative. One study found that during
hypotensive episodes, NIBP measurements of systolic
pressure were often higher than the corresponding

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CSA Vital Times

systolic invasive arterial blood pressure (IABP)
readings. When systolic hypotension did occur, the
group being monitored by NIBP values was associated
with having significantly higher AKI and ICU mortality
as compared to the group with similar IABP values.5
IABP offers continuous blood pressure monitoring,
and facilitates collection of arterial blood gases. The
arterial catheter can be used in conjunction with
auto-calibrated pressure waveform analysis devices,
such as FloTrac (Edwards Lifesciences, Irvine, CA),
which calculate the stroke volume and CO. However,
invasive vascular access introduces the potential
for complications such as infection, hematoma, and
ischemia.6
The pulmonary artery catheter (PAC) is the gold
standard for measuring intracardiac pressure,
CO, and mixed venous oxygen saturation. PACs
are invasive and require well-trained providers for
placement and interpretation. Complications from
PAC placement are rare, but consequences are
significant: pulmonary artery rupture, arrhythmias,
heart block, bleeding, and infection.7 As such, PAC use
has significantly decreased with the advent of new
monitoring devices.1,8 Although studies have failed to
demonstrate a correlation between the use of PACs
and survival in patients undergoing high-risk surgery
or in the ICU setting9,10 PACs remain a valuable tool.11
Recently, hemodynamic monitoring devices have
progressed towards non-invasive modalities. Ideally,
non-invasive hemodynamic monitors should provide



Vital Times 2020

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