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reliable, consistent data that accurately predicts
responsiveness to fluids and vasopressors, while
avoiding the complications of invasive devices. The
resultant measurements should be comparable, if
not identical to PAC measures even during dynamic
states. Monitors should also be portable and easy
to use across multiple clinical settings. While there
are currently no hemodynamic monitors that meet
all of the aforementioned criteria, devices that offer
non-invasive continuous hemodynamic monitoring
have demonstrated encouraging results in providing
continuous blood pressure and hemodynamic
parameters, such as CO, stroke volume, stroke volume
variation, systemic vascular resistance, and mean
arterial pressure.12 These innovative non-invasive
systems derive hemodynamic parameters from a
variety of methods, including pulse contour analysis,

bioimpedance, bioreactance, pulse wave transit time,
or partial carbon dioxide rebreathing.
The non-invasive pulse contour devices have
shown promising results with their ability to
assess intravascular volume responsiveness, user
friendliness, and ease of calibration. These monitors
employ finger-cuff technology with a built-in
plethysmograph sensor to non-invasively measure
finger arterial blood pressure utilizing the volume
clamp method (Figure 1). This approach dynamically
provides equal pressure across the wall of the artery
by maintaining a constant volume within the artery.14
Pulsations within the finger are used to reconstruct
the brachial arterial pressure waveform, providing
a nearly continuous measure of blood pressure14
(Figures 2 and 3).

Figure 1. Finger-cuff technology utilizing the volume-clamp analysis method with an inflatable finger-cuff. Adapted from Edwards Life
Sciences and Saugel et al.15 Cuff pressure is adjusted 1000 times per second to maintain a constant diameter of the finger arteries, which then
produces a continuous real-time pressure waveform.

Figure 2. ClearSight system providing continuous noninvasive blood pressure with waveform, along with advanced hemodynamic parameters
to evaluate hemodynamic instability and guide treatment. Systemic vascular resistance, stroke volume variation, and cardiac index variables
are demonstrated in this image.

Annual Publication 2020

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Vital Times 2020

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