Friday, April 7, 2017

Non-Invasive Hemodynamic Monitoring

R.E.B.E.L.EM - April 6, 2017 - Post Peer Reviewed By: Anand Swaminathan
"Background: Many physicians struggle with monitoring accurate continuous blood pressures, cardiac output, and response to fluids in patient resuscitation. Also, due to the invasive nature of most methods presently available (i.e. arterial lines, etc) few patients get this monitoring. Ultrasound has been an amazing addition to our armamentarium, but many, I am sad to say, still don’t feel comfortable with this modality. Recently, finger cuff, non-invasive technology was brought to my attention by Bob Frolichstein, one of my colleagues in San Antonio, TX. Specifically, it has been stated that, finger cuff technology, allows hemodynamic monitoring with both BP and CO continuously available in patients without the need for an arterial line.
Author Conclusion: “Presenting ED noninvasive HD data has not been previously reported in any large patient population. Our data suggest a potential role for early noninvasive HD assessments aiding in diagnosing of patients, individualizing therapy based on each person’s unique HD values and predicting 30-day mortality. Further studies and analyses are needed to determine how HD assessments should be best used in the ED.”
Clinical Take Home Point: At this time, finger cuff non-invasive hemodynamic monitoring devices are not ready for primetime. There is no strong evidence that they are accurate in a sick ED population, or that using them affects outcomes of our patients. This just appears to be a very expensive toy, that has not proven that it can do better than what we already do."