Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section A. Monitoring the Anesthesia Patient > Chapter 29. Hemodynamic Monitoring Shahar Bar-Yosef, MD, Rebecca A. Schroeder, MD, and Jonathan B. Mark, MD

Key Points

"1. When interpreting invasive hemodynamic pressures, consideration should be given to technical aspects including the zero reference level, dynamic response of the monitoring system, and the effects of changes in intrathoracic pressures.

2. Much diagnostic information can be gleaned from the analog waveform of directly measured pressures, both arterial blood pressure and cardiac filling pressures.

3. The interpretation of filling pressures like central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) is confounded by many variables, notably changes in ventricular compliance, valvular abnormalities, and positive pressure ventilation.

4. Use of the pulmonary artery catheter for monitoring without a structured therapeutic intervention protocol has generally been found not to be beneficial in most perioperative and critical care settings. It might still be justified in very-high-risk patients or in critically ill patients who do not respond to empiric therapy.

5. There are no accepted "gold standards" for cardiac output measurement. With this in mind, it is more clinically useful to follow trends in cardiac output rather than consider absolute values.

6. Functional indices based on respiratory variation in hemodynamic parameters are better predictors of fluid responsiveness compared to static filling pressures or volumetric..."