Haemodynamic monitoring in acute heart failure – what you need to know

Abstract

Acute heart failure (AHF) is a sudden, life-threatening condition, defined as a gradual or rapid onset of symptoms and/or signs of HF. AHF requires urgent medical attention, being the most frequent cause of unplanned hospital admission in patients above 65 years of age. AHF is associated with a 4-12% in-hospital mortality rate and a 21-35% 1-year mortality rate post-discharge. Considering the serious prognosis in AHF patients, it is very important to understand the mechanisms and haemodynamic status in an individual AHF patient, thus preventing end-organ failure and death. Haemodynamic monitoring is a serial assessment of cardiovascular function, intended to detect physiologic abnormalities at the earliest stages, determine which interventions could be most effective, and provide the basis for initiating the most appropriate therapy and evaluate its effects. Over the past decades, haemodynamic monitoring techniques have evolved greatly. Nowadays, they range from very invasive to non-invasive, from intermittent to continuous, and in terms of the provided parameters. Invasive techniques contain pulmonary artery catheterization and transpulmonary thermodilution. Minimally invasive techniques include oesophageal Doppler and noncalibrated pulse wave analysis. Non-invasive techniques contain echocardiography, bioimpedance, and bioreactance techniques as well as non-invasive pulse contour methods. Each of these techniques has specific indications and limitations. In this article, we aimed to provide a pathophysiological explanation of the physical terms and parameters used for haemodynamic monitoring in AHF and to summarize the working principles, advantages, and disadvantages of the currently used methods of haemodynamic monitoring.

“Effect of pulmonary artery catheterization in patients with non-ischemic cardiogenic shock: a nationwide analysis”

“…We observed a remarkable institutional variation in the use of PAC for invasive monitoring of patients with nonischemic CS, as the use of PAC was higher in large hospitals in an urban environment, and in areas with higher income levels. These differences in use have also been observed in previous studies (22–24). It is expected that the emergence of CS code initiatives will further accentuate these discrepancies, as the care of these patients tends to be centralized in a few specialized centers (25–27).…”

“…These differences in use have also been observed in previous studies (22)(23)(24). It is expected that the emergence of CS code initiatives will further accentuate these discrepancies, as the care of these patients tends to be centralized in a few specialized centers (25)(26)(27).…”

The association of body composition assessment with hospital length of stay in off-pump coronary artery bypass patients

“…In consequence, it is obligatory to describe the range of change of FFM during recovery from CABG surgery, which is of particular importance in the case of persistent FFM wasting after the operation [ 27 ]. Further research should examine whether such optimized early rehabilitation programs combined with the implementation of nutritional care could prevent or reverse FFM deterioration after CABG surgery [ 17 , 28 ].…”