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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Pitfalls in haemodynamic monitoring based on the arterial pressure waveform. | Camporota and Beale Critical Care 2010 14 124 http ccforum.eom content 14 2 124 CRITICAL CARE COMMENTARY L__ Pitfalls in haemodynamic monitoring based on the arterial pressure waveform Luigi Camporota and Richard Beale See related research of Eleftheriadis etal. http ccforum.eom content 13 6 R179 Abstract The accuracy of the arterial pressure-based cardiac output FloTrac-Vigileo system remains unacceptably low during haemodynamic instability. Data show that the measurement of cardiac output CO is strongly influenced by changes in factors that affect arterial blood pressure ABP - for example vascular tone and compliance and the arterial site - independently of true changes in CO. Although in theory the autocalibration algorithm of FloTrac-Vigileo should adjust for those changes the model undercompensates or overcompensates for prominent increases or decreases in vascular tone and compliance making the system largely dependent on changes in ABP. These limitations make FloTrac-Vigileo accurate in stable haemodynamic conditions only and until more robust algorithms and further validation studies become available we should be aware that during haemodynamic instability or in extreme conditions of vasodilation or vasoconstriction the measured CO may diverge from an independent bolus indicator dilution measurement particularly if a peripheral artery is used. In these conditions we advocate the use of transpulmonary indicator dilution via a femoral artery. In recent years there has been a trend toward the use in intensive care units ICUs and in operating theatres of minimally invasive haemodynamic monitoring systems for the continuous measurement of cardiac output CO . In this context minimally invasive has come to mean less invasive than a pulmonary artery catheter and is arguably an unhelpful term. Nevertheless among the available devices the FloTrac-Vigileo system FTV Edwards Correspondence richard.beale@gstt.nhs.uk Department of Adult Critical Care - Guy s and
