Personalized hemodynamic management

Abstract

Purpose of review: To describe personalized hemodynamic management of critically ill patients in the operating room and the ICU.

Recent findings: Several recent clinical studies have investigated different strategies for optimizing blood pressure (BP) and flow in the operating room and in the ICU. In the past, (early) goal-directed hemodynamic treatment strategies often used predefined fixed population-based 'normal' values as hemodynamic targets. Most hemodynamic variables, however, have large interindividual variability and are dependent on several biometric factors. Personalized BP management aims to set specific BP targets for a given patient taking into account blood flow autoregulation and any history of chronic hypertension. To optimize cardiac output and oxygen delivery, individualized hemodynamic management based on functional assessment of fluid responsiveness is used. Innovative noninvasive technologies now enable preoperative assessment of a patient's personal normal hemodynamic values, which can then be targeted in the perioperative phase. In critically ill patients admitted to the ICU, adaptive multiparametric hemodynamic monitoring can help to personalize hemodynamic management.

Summary: Personalized hemodynamic management targets personal normal values of hemodynamic variables, which are adjusted to biometric data and adapted to the clinical situation (i.e., adequate values). This approach optimizes cardiovascular dynamics based on the patient's personal hemodynamic profile.