Is There a Role for Invasive Hemodynamic Monitoring in Acute Heart Failure Management?

Abstract

The place of invasive hemodynamic monitoring in patients with acute heart failure is still debated, even though frequently used. Invasive techniques, which include the pulmonary artery catheter and transpulmonary thermodilution, provide important information on cardiac output and intravascular pressures or volume. These techniques should be used in combination with echocardiography and allow nurse-driven semicontinuous hemodynamic monitoring. These techniques are useful not only in the diagnosis of circulatory or respiratory failure but also for the evaluation of the effects of therapies. Admittedly, large-scale randomized trials failed to demonstrate a survival benefit with the pulmonary artery catheter (and were even not yet performed with transpulmonary thermodilution). However, these trials may be subjected to selection bias, as patients from recruiting centers not included in the trial but receiving the pulmonary artery catheter were more severe and had higher mortality rates than patient included in the trial. Hence, invasive techniques may still have a place in selected patients with acute circulatory failure and especially in the most severe cases.

Informatics Solutions for Application of Decision-Making Skills

“…Monitoring devices used in the ICU, such as arterial pressure or pulmonary artery catheters, capture semi-continuous values that allow for nurse-driven monitoring and evaluation of the therapeutic effect of interventions. 9 The monitoring devices communicate with the EHR over a secure network, wirelessly or directly with an Ethernet converter. 10 The ICU nurse determines the frequency that the data are captured, validates that the data collected are accurate, and then saves them to the patient’s permanent EHR.…”

“…11 Nursing practice includes determination of appropriate pharmacologic and non-pharmacologic interventions. 9 Nursing decision support could provide recommendations that include assessment of mixed venous oxygen saturation (SvO2), through repeated blood withdrawal from the pulmonary artery catheter, as an indicator of the oxygen supply/demand balance. 13 SvO2<50% requires the ICU nurse to perform a rapid patient assessment and to provide physiologic optimization which may include oxygen administration, fluid infusion, diuretics, vasopressors, and/or inotropes.…”

Monitoring Acute Myocardial Infarction Complicated with Cardiogenic Shock — from the Emergency Room to Coronary Care Units

“…131,132 Central venous pressure (CVP) is a marker that illustrates intravascular volume and right ventricular function, being measured by inserting a catheter in the su- The invasive assessment of CO and stroke volume is performed by Swan Ganz catheterization using the thermodilution method, which also allows the evaluation of right cardiac pressures and the pulmonary capillary wedge pressure, being largely used in CCUs for invasive hemodynamic monitoring. [134][135][136][137] Other invasively assessed parameters used in the CCU for critical AMI patients are those reflecting ventricular contractility such as the left ventricular stroke volume and the mechanical work, which can indicate whether inotropes or vasodilator therapies are required. 138,139 The pressures in the right ventricular and pulmonary artery illustrate the pulmonary circulation, while the capillary wedge pressure reflects the end-diastolic pressure in the left ventricle, indicating the preload alteration and estimating the systolic and diastolic function of the left heart chambers.…”

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

“…Differentiation of clinical conditions based on parameters obtained by pulmonary artery catheter[17] …”

“…Differentiation of clinical conditions based on parameters obtained by transpulmonary thermodilution[17] CFI -cardiac function index, EVLW -extra-vascular lung water, GEDV -global end-diastolic volume, H -higher than normal, L -lower than normal, N -normal.…”