Bench-to-bedside review: An approach to hemodynamic monitoring

Bench-to-bedside review: An approach to hemodynamic monitoring - Guyton at the bedside.

MedLine Citation:	PMID: 23106914 Owner: NLM Status: Publisher
Abstract/OtherAbstract:	ABSTRACT: Hemodynamic monitoring is used to identify deviations from hemodynamic goals and to assess responses to therapy. To accomplish these goals one must understand how the circulation is regulated. In this review I begin with an historical review of the work of Arthur Guyton and his conceptual understanding of the circulation and then present an approach by which Guyton's concepts can be applied at the bedside. Guyton argued that cardiac output and central venous pressure are determined by the interaction of two functions: cardiac function, which is determined by cardiac performance; and a return function, which is determined by the return of blood to the heart. This means that changes in cardiac output are dependent upon changes of one of these two functions or of both. I start with an approach based on the approximation that blood pressure is determined by the product of cardiac output and systemic vascular resistance and that cardiac output is determined by cardiac function and venous return. A fall in blood pressure with no change in or a rise in cardiac output indicates that a decrease in vascular resistance is the dominant factor. If the fall in blood pressure is due to a fall in cardiac output then the role of a change in the return function and cardiac function can be separated by the patterns of changes in central venous pressure and cardiac output. Measurement of cardiac output is a central component to this approach but until recently it was not easy to obtain and was estimated from surrogates. However, there are now a number of non-invasive devices that can give measures of cardiac output and permit the use of physiological principles to more rapidly appreciate the primary pathophysiology behind hemodynamic abnormalities and to provide directed therapy.

Authors:	Sheldon Magder
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Publication Detail:	Type: JOURNAL ARTICLE Date: 2012-10-29
Journal Detail:	Title: Critical care (London, England) Volume: 16 ISSN: 1466-609X ISO Abbreviation: Crit Care Publication Date: 2012 Oct
Date Detail:	Created Date: 2012-10-30 Completed Date: - Revised Date: -
Medline Journal Info:	Nlm Unique ID: 9801902 Medline TA: Crit Care Country: -
Other Details:	Languages: ENG Pagination: 236 Citation Subset: -
Affiliation:	McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1. sheldon.magder@muhc.mcgill.ca.
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