Hemodynamic monitoring in sepsis

Abstract

Arterial waveform analysis that does not require continuous calibration, impedance cardiography, electrical cardiometry, velocity-encoded phase contrast magnetic resonance imaging (MRI), pulsed dye densitometry, noninvasive pulse pressure analysis using tonometry, suprasternal Doppler, partial CO2 rebreathing techniques, and transcutaneous Doppler are just some of the other emerging technologies not described in this review that may be used routinely in the management of sepsis and septic shock in the very near future. These innovative approaches may further increase our ability to optimize patients' fluid status and hemodynamics. We also have ability to monitor the microcirculation. This increasingly sophisticated approach to the management of sepsis and septic shock will hopefully translate into better patient outcomes. However, optimal use of any hemodynamic monitoring requires an understanding of its physiologic underpinnings. Accurate interpretation of the hemodynamic information coupled with a protocolized management algorithm is the cornerstone of an effective resuscitation effort. Many forms of hemodynamic monitoring have emerged over the past 20 to 30 years with no convincing evidence for the superiority of any single techniques (Table 2). The goal of hemodynamic monitoring and optimization is to combat the systemic imbalance between tissue oxygen supply and demand ranging from global tissue hypoxia to overt shock and multiorgan failure. It remains unproven that hemodynamic monitoring of disease progression can effectively change patient outcome. However, despite our increased understanding of sepsis pathophysiology, mortality and morbidity from the disease remains high. Therefore, the search for the optimal parameters in resuscitation and the best way they can be monitored will continue.