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

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.

Fig. 1

Haemodynamic variables determining perfusion pressure and oxygen delivery

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

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

Central venous pressure curve

Fig. 5

Cardiac output monitoring methods classified according to their invasiveness into invasive, minimally-invasive, and noninvasive methods

Fig. 6

Classification of pulse wave analysis according to invasiveness, type of calibration, and need for dedicated equipment