Improving Perioperative Outcomes Through Minimally Invasive and Non-invasive Hemodynamic Monitoring Techniques

Abstract

An increasing number of patients require precise intraoperative hemodynamic monitoring due to aging and comorbidities. To prevent undesirable outcomes from intraoperative hypotension or hypoperfusion, appropriate threshold settings are required. These setting can vary widely from patient to patient. Goal-directed therapy techniques allow for flow monitoring as the standard for perioperative fluid management. Based on the concept of personalized medicine, individual assessment and treatment are more advantageous than conventional or uniform interventions. The recent development of minimally and noninvasive monitoring devices make it possible to apply detailed control, tracking, and observation of broad patient populations, all while reducing adverse complications. In this manuscript, we review the monitoring features of each device, together with possible advantages and disadvantages of their use in optimizing patient hemodynamic management.

Keywords: blood pressure; hemodynamic; hemodynamic monitoring; monitor; non-invasive; outcomes; perioperative complications; perioperative outcomes.

Figure 1

(A) Ohm's low and hemodynamic equation. (B) E (voltage) = I (current) × R (resistance) (MAP-CVP) = CO × SVR. MAP, mean arterial pressure; CVP, central venous pressure; CO, cardiac output; SVR, systemic vascular resistance. (C) The basic 2-element Windkessel model. Elastic artery has specific compliance and behaves as a capacitor. The relation given as: $\text{I}(\text{t})=\frac{\text{P}(\text{t})}{\text{R}}+\text{C}\frac{\text{dP}(\text{t})}{\text{dt}}$ The 3- and 4-element models as a succeeding model are used in recent devices with more accuracy.