Pulse wave analysis - basic concepts and clinical application in intensive care medicine

TY - JOUR

T1 - Pulse wave analysis - basic concepts and clinical application in intensive care medicine

AU - Thomsen, Kristen K

AU - Kouz, Karim

AU - Saugel, Bernd

N1 - Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2023/6/1

Y1 - 2023/6/1

N2 - PURPOSE OF REVIEW: The measurement of cardiac output (CO) is important in patients with circulatory shock. Pulse wave analysis (PWA) estimates CO continuously and in real-time using the mathematical analysis of the arterial pressure waveform. We describe different PWA methods and provide a framework for CO monitoring using PWA in critically ill patients.RECENT FINDINGS: PWA monitoring systems can be classified according to their invasiveness (into invasive, minimally invasive, and noninvasive systems) and their calibration method (into externally calibrated, internally calibrated, and uncalibrated systems). PWA requires optimal arterial pressure waveform signals. Marked alterations and rapid changes in systemic vascular resistance and vasomotor tone can impair the measurement performance of PWA.SUMMARY: Noninvasive PWA methods are generally not recommended in critically ill patients (who have arterial catheters anyway). PWA systems can be used to continuously track stroke volume and CO in real-time during tests of fluid responsiveness or during therapeutic interventions. During fluid challenges, continuous CO monitoring is important because - if CO decreases - a fluid challenge can be stopped early to avoid further unnecessary fluid administration. PWA externally calibrated to indicator dilution methods can be used - in addition to echocardiography - to diagnose the type of shock.

AB - PURPOSE OF REVIEW: The measurement of cardiac output (CO) is important in patients with circulatory shock. Pulse wave analysis (PWA) estimates CO continuously and in real-time using the mathematical analysis of the arterial pressure waveform. We describe different PWA methods and provide a framework for CO monitoring using PWA in critically ill patients.RECENT FINDINGS: PWA monitoring systems can be classified according to their invasiveness (into invasive, minimally invasive, and noninvasive systems) and their calibration method (into externally calibrated, internally calibrated, and uncalibrated systems). PWA requires optimal arterial pressure waveform signals. Marked alterations and rapid changes in systemic vascular resistance and vasomotor tone can impair the measurement performance of PWA.SUMMARY: Noninvasive PWA methods are generally not recommended in critically ill patients (who have arterial catheters anyway). PWA systems can be used to continuously track stroke volume and CO in real-time during tests of fluid responsiveness or during therapeutic interventions. During fluid challenges, continuous CO monitoring is important because - if CO decreases - a fluid challenge can be stopped early to avoid further unnecessary fluid administration. PWA externally calibrated to indicator dilution methods can be used - in addition to echocardiography - to diagnose the type of shock.

KW - Arterial Pressure

KW - Cardiac Output

KW - Critical Care

KW - Critical Illness

KW - Heart Rate

KW - Humans

U2 - 10.1097/MCC.0000000000001039

DO - 10.1097/MCC.0000000000001039

M3 - SCORING: Review article

C2 - 37078625

VL - 29

SP - 215

EP - 222

JO - CURR OPIN CRIT CARE

JF - CURR OPIN CRIT CARE

SN - 1070-5295

IS - 3

ER -