Chapter 10. Hemodynamic Monitoring

John P Kress, MD, FCCP
DOI: 10.1378/critcare.21.10
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  • Describe tools to assess adequacy of tissue perfusion.

  • Describe etiologies of hypoperfusion.

  • Describe ways to assess the response of the cardiopulmonary system to interventions for managing a hypoperfused state.


Hemodynamic monitoring may be defined as the collection and interpretation of various parameters that determine: (1) the adequacy of tissue perfusion; (2) the etiology of a hypoperfused state; and (3) the response of the cardiopulmonary system to interventions such as fluid therapy, vasoactive drugs, or adjustments in positive pressure ventilation. For many patients, adequate monitoring is achieved by routine vital signs along with collection of data such as history and physical examination, laboratory data (eg, BUN/creatinine, Hco3 , lactate, Scvo2, Svo2), input/output, and urine electrolytes. In other patients, invasive measurements are made, including use of arterial catheters, central venous catheters, and right heart catheters. These catheters provide for continuous transduction of pressure in either the arterial or venous circuit and sampling of blood for determination of oxygen saturation. Simultaneous determination of arterial and mixed venous blood gases also permits determination of oxygen content, oxygen delivery, oxygen consumption, arteriovenous oxygen content difference, and calculation of cardiac output by Fick determination.


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