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Review
. 2024 Jun;38(3):565-580.
doi: 10.1007/s10877-024-01161-2. Epub 2024 Apr 30.

Haemodynamic monitoring during noncardiac surgery: past, present, and future

Karim Kouz  1   2 , Robert Thiele  3 , Frederic Michard  4 , Bernd Saugel  5   6
Affiliations
Review

Haemodynamic monitoring during noncardiac surgery: past, present, and future

Karim Kouz et al. J Clin Monit Comput. 2024 Jun.

Abstract

During surgery, various haemodynamic variables are monitored and optimised to maintain organ perfusion pressure and oxygen delivery - and to eventually improve outcomes. Important haemodynamic variables that provide an understanding of most pathophysiologic haemodynamic conditions during surgery include heart rate, arterial pressure, central venous pressure, pulse pressure variation/stroke volume variation, stroke volume, and cardiac output. A basic physiologic and pathophysiologic understanding of these haemodynamic variables and the corresponding monitoring methods is essential. We therefore revisit the pathophysiologic rationale for intraoperative monitoring of haemodynamic variables, describe the history, current use, and future technological developments of monitoring methods, and finally briefly summarise the evidence that haemodynamic management can improve patient-centred outcomes.

Keywords: Anaesthesia; Blood pressure; Cardiac output; Haemodynamic monitoring; Heart rate.

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Conflict of interest statement

KK is a consultant for and has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). KK is a consultant for Vygon (Aachen, Germany). RT performs consulting work on advanced monitoring technology for Medtronic, Edwards Lifesciences, and Philips Medical. RT received an investigator-initiated award from Apple to explore the use of exercise training in patients undergoing cancer surgery. RT has an NIH Grant (R-21, NIBIB) to develop near-infrared spectroscopy equipment to measure the oxidation state of cytochrome aa non-invasively. FM is the founder and managing director of MiCo (MichardConsulting.com), a consulting and research firm based in Switzerland. MiCo does not sell any medical devices, and FM does not own shares and does not receive patent royalties from any medical device company. BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). BS is a consultant for Philips North America (Cambridge, MA, USA) and has received honoraria for giving lectures from Philips Medizin Systeme Böblingen (Böblingen, Germany). BS has received institutional restricted research grants and honoraria for giving lectures from Baxter (Deerfield, IL, USA). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from GE Healthcare (Chicago, IL, USA). BS has received institutional restricted research grants and honoraria for giving lectures from CNSystems Medizintechnik (Graz, Austria). BS is a consultant for Maquet Critical Care (Solna, Sweden). BS has received honoraria for giving lectures from Getinge (Gothenburg, Sweden). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Pulsion Medical Systems (Feldkirchen, Germany). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Vygon (Aachen, Germany). BS is a consultant for and has received institutional restricted research grants from Retia Medical (Valhalla, NY, USA). BS has received honoraria for giving lectures from Masimo (Neuchâtel, Switzerland). BS is a consultant for Dynocardia (Cambridge, MA, USA). BS has received institutional restricted research grants from Osypka Medical (Berlin, Germany). BS was a consultant for and has received institutional restricted research grants from Tensys Medical (San Diego, CA, USA). BS is an Editor of the British Journal of Anaesthesia.

Figures

Fig. 1
Fig. 1
Haemodynamic variables determining perfusion pressure and oxygen delivery
Fig. 2
Fig. 2
Dynamic response of the arterial pressure measurement system. This figure illustrates an adequately damped arterial pressure waveform and characteristic changes of the arterial pressure waveform when underdamping and overdamping is present. The red arterial pressure waveform represents a “normal,” non-distorted waveform with a normal fast-flush test, whereas the blue arterial pressure waveforms represent an underdamped (upper part of the figure) or overdamped (lower part of the figure) arterial pressure waveform. PP, pulse pressure; SAP, systolic arterial pressure; DAP, diastolic arterial pressure. “Under- and overdamping of the arterial blood pressure waveform and fast-flush test” by Saugel et al. [42] is licensed under CC BY 4.0
Fig. 3
Fig. 3
Cyclic changes in arterial pressure during mechanical ventilation and calculation of the dynamic cardiac preload variables pulse pressure variation and stroke volume variation. PP, pulse pressure; PPV: pulse pressure variation; SV, stroke volume; SVV, stroke volume variation
Fig. 4
Fig. 4
Central venous pressure curve
Fig. 5
Fig. 5
Cardiac output monitoring methods classified according to their invasiveness into invasive, minimally-invasive, and noninvasive methods
Fig. 6
Fig. 6
Classification of pulse wave analysis according to invasiveness, type of calibration, and need for dedicated equipment
See this image and copyright information in PMC

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