Hemodynamic Status in Critically III Patients with and without Acute Heart Disease

Connors, Alfred F.; Dawson, Neal V.; Shaw, Patricia K.; Montenegro, Hugo; Nara, Andrew R.; Martin, Lawrence

doi:10.1378/chest.98.5.1200

Cited by 50 publications

(18 citation statements)

References 19 publications

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“…Whether hemodynamic data led to a more tailored approach to selection and monitoring of antihypertensive agents or by other factors, it resulted in greater reduction in BP and SVRI and better BP control. Physicians cannot adequately estimate hemodynamics from routine clinical examination or BP measurements, 23 because at similar levels of BP, SVR and CO can vary widely. Therefore, the addition of accurate, noninvasive, and readily obtainable hemodynamic measurements is clinically relevant.…”

Section: Smith Et Al Noninvasive Hemodynamics and Bp Control 775mentioning

confidence: 99%

Value of Noninvasive Hemodynamics to Achieve Blood Pressure Control in Hypertensive Subjects

2006

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Abstract-Abnormal hemodynamics play a central role in the development and perpetuation of high blood pressure. We hypothesized that hypertension therapy guided by noninvasive hemodynamics with impedance cardiography could aid primary care physicians in reducing blood pressure more effectively. Uncontrolled hypertensive patients on 1 to 3 medications were randomized by 3:2 ratio to either a standard arm or hemodynamic arm that used impedance cardiography (BioZ, CardioDynamics). Each patient completed 5 study visits with a 2-week washout period followed by 3 months of treatment. A total of 164 patients from 11 centers completed the study, 95 in the standard arm and 69 in the hemodynamic arm. At baseline and after washout, there were no differences between arms in number of medications or demographic, blood pressure, or hemodynamic characteristics. Hypertension is a major public health concern, because it significantly increases risk of coronary artery disease, heart failure, renal disease, and stroke. 4 In spite of major public health and medical education efforts and availability of effective antihypertensive agents, blood pressure (BP) control rates in the United States remain low, with only 31% of hypertensives and 54% of those actively treated and taking medications achieving BP Ͻ140/90 mm Hg. 5 Why is BP control such an elusive goal? The reasons are numerous and complex. However, inadequate pharmacological treatment remains the most common cause of uncontrolled BP in actively treated patients. 6 Hypertension is a hemodynamic-related disorder. BP rises as the result of increased systemic vascular resistance (SVR), cardiac output (CO), fluid volume, or a combination of these factors. 7,8 Consequently, antihypertensive agents lower BP by reducing SVR, CO, fluid volume, or combinations thereof. 9 Previous authors hypothesized that hemodynamic information could help tailor therapy and subsequently improve BP control. 10 Invasive procedures for hemodynamic profiling are not warranted in outpatient clinics, and noninvasive procedures, such as echocardiography, are costly and operator dependent. 11 Impedance cardiography (ICG) has emerged as a reliable noninvasive method to measure hemodynamics in physician offices. In a randomized, controlled trial, ICG-guided treatment improved BP control rates in resistant hypertension treated by hypertension specialists. 12 We hypothesized that ICG-guided treatment could aid physicians in reducing BP more effectively than standard care in a population of uncontrolled hypertensive patients receiving 1 to 3 medications in a primary care setting. Methods EligibilityMale and female patients (age range, 18 to 75 years) were eligible if they had a diagnosis of essential hypertension and were currently on

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Section: Smith Et Al Noninvasive Hemodynamics and Bp Control 775mentioning

confidence: 99%

Value of Noninvasive Hemodynamics to Achieve Blood Pressure Control in Hypertensive Subjects

2006

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“…Pulmonary artery catheterization is useful to assess the hemodynamic status and to guide the treatment of the patient with cardiogenic shock more precisely than with the clinical exam [123][124][125][126] . Its indications in the acute myocardial infarction are 127 cardiogenic shock, suspected mechanical complications due to the infarction such as rupture of the papillary muscle, rupture of interventricular septum or pericardial tamponade, nonresponsive arterial hypertension, administration of volume in the absence of pulmonary congestion, such as in the right ventricular infarction.…”

Section: Monitoringmentioning

confidence: 99%

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

Bocchi¹,

Vilas-Boas²,

Perrone³

et al. 2005

Arq. Bras. Cardiol.

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“…Although the values obtained in these assessments somewhat correlate with hemodynamic variables, the values are slow to change and the changes are often late indications of a patient's worsening condition. [3][4][5] Several studies [10][11][12][13][14][15][16][17] suggest that using physical assessment to evaluate cardiac output may yield inaccurate findings. More recent data [18][19][20] suggest that the predictive power of blood lactate levels for mortality and morbidity are independent of blood pressure and common physiological triage variables (eg, heart rate, blood pressure, mental status, capillary refill).…”

Section: Limitations Of Conventional Assessmentsmentioning

confidence: 99%

Stroke Volume Optimization: The New Hemodynamic Algorithm

Johnson

Ahrens

2015

Critical Care Nurse

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Critical care practices have evolved to rely more on physical assessments for monitoring cardiac output and evaluating fluid volume status because these assessments are less invasive and more convenient to use than is a pulmonary artery catheter. Despite this trend, level of consciousness, central venous pressure, urine output, heart rate, and blood pressure remain assessments that are slow to be changed, potentially misleading, and often manifested as late indications of decreased cardiac output. The hemodynamic optimization strategy called stroke volume optimization might provide a proactive guide for clinicians to optimize a patient’s status before late indications of a worsening condition occur. The evidence supporting use of the stroke volume optimization algorithm to treat hypovolemia is increasing. Many of the cardiac output monitor technologies today measure stroke volume, as well as the parameters that comprise stroke volume: preload, afterload, and contractility.

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Hemodynamic Status in Critically III Patients with and without Acute Heart Disease

Cited by 50 publications

References 19 publications

Value of Noninvasive Hemodynamics to Achieve Blood Pressure Control in Hypertensive Subjects

Value of Noninvasive Hemodynamics to Achieve Blood Pressure Control in Hypertensive Subjects

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

Stroke Volume Optimization: The New Hemodynamic Algorithm

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