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Anästhesiol Intensivmed Notfallmed Schmerzther 2008; 43(5): 364-373
DOI: 10.1055/s-2008-1079111
Fachwissen
Topthema:Monitoring in der Anästhesie
© Georg Thieme Verlag Stuttgart · New York

Perioperatives hämodynamisches Monitoring – ein Überlebensvorteil für anästhesiologisch betreute Patienten?

Hemodynamic monitoring in the perioperative periodJürgen Graf, Marc Irqsusi, Uwe Janssens
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Publication History

Publication Date:
08 May 2008 (online)

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Zusammenfassung

Das perioperative hämodynamische Monitoring kann in ein obligates, nicht invasives Basismonitoring und ein erweitertes hämodynamisches Monitoring unterteilt werden. Sowohl patienten–, als auch operationsspezifische Aspekte können die Indikation für eine Erweiterung des hämodynamischen Monitorings darstellen. Nutzen und Qualität der perioperativen Patientenüberwachung hängen ausschließlich von der Kenntnis der Möglichkeiten und Limitationen der eingesetzten Monitoringinstrumente ab.

Abstract

Both, obligatory non–invasive hemodynamic monitoring and adjunctive hemodynamic monitoring need to be considered perioperatively. Patient as well as surgical requirements may contribute to the decision making process. Effectiveness and quality of the perioperative patient monitoring solely depends on the knowledge and awareness of the anesthesist with regard to the potentials and limitations of the applied monitoring.

Schlüsselwörter:

Monitoring; Anästhesie - Herz–Kreislauf–System; Hämodynamik

Key words:

monitoring; anesthesia - cardio–vascular system; hemodynamic

Kernaussagen

  • Die häufigsten Ursachen perioperativer Morbidität und Letalität stellen kardiovaskuläre Erkrankungen dar.

  • Das Ziel des hämodynamischen Monitorings ist die Sicherstellung einer adäquatenOrganperfusion mit entsprechender Organoxygenierung und –nutrition.

  • Das erweiterte hämodynamische Monitoring allein verbessert die Patientenprognose nicht, ist aber mit einer Zunahme von Risiken und Komplikationen assoziiert.

  • Möglichkeiten, Grenzen, Risiken und das spezifische Fehlerpotential der eingesetzten Messinstrumente sollten dem Anwender bekannt sein.

  • Allein die Kenntnis des Anästhesisten entscheidet, ob ein Überwachungsverfahren nützlich oder schädlich ist.

Literaturverzeichnis

  • 1 Mallon J. W.. Ernest Amory Codman: The End Result of a Life in Medicine. 1st ed. W.B. Saunders 2000
    Google Scholar
  • 2 Janssens U.. Hämodynamisches Monitoring.  Internist. 2000;  41 995-1010
    CrossrefPubMedGoogle Scholar
  • 3 Mangano DT. et al. . Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group.  N Engl J Med. 1990;  323 1781-1788
    CrossrefPubMedGoogle Scholar
  • 4 Jain U. et al. . Electrocardiographic and hemodynamic changes and their association with myocardial infarction during coronary artery bypass surgery. A multicenter study. Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Anesthesiology. 1997;  86 576-591
    CrossrefPubMedGoogle Scholar
  • 5 Browner WS. et al. . In–hospital and long–term mortality in male veterans following noncardiac surgery. The Study of Perioperative Ischemia Research Group.  JAMA. 1992;  268 228-232
    CrossrefPubMedGoogle Scholar
  • 6 Marsch SC. et al. . Failure of continuous three–channel Holter monitoring to detect acute peri–operative myocardial infarction.  Anaesthesia. 1992;  47 34-37
    CrossrefPubMedGoogle Scholar
  • 7 Buhre W. et al. . Perioperative management and monitoring in anaesthesia.  Lancet. 2003;  362 1839-1846
    CrossrefPubMedGoogle Scholar
  • 8 London MJ. et al. . Intraoperative myocardial ischemia: localization by continuous 12–lead electrocardiography.  Anesthesiology. 1988;  69 232-241
    CrossrefPubMedGoogle Scholar
  • 9 Drummond JC.. The lower limit of autoregulation: time to revise our thinking?.  Anesthesiology. 1997;  86 1431-1433
    CrossrefPubMedGoogle Scholar
  • 10 Ramsey M.. Blood pressure monitoring: automated oscillometric devices.  J Clin Monit. 1991;  7 56-67
    CrossrefPubMedGoogle Scholar
  • 11 Perloff D. et al. . AHA Medical/Scientific Statement Special Report: Human blood pressure determination by sphygmomanometry.  Circulation. 1993;  88 2460-2470
    CrossrefPubMedGoogle Scholar
  • 12 Graf J, Janssens U.. Methoden und mögliche Fehlerquellen beim hämodynamischen Monitoring. In: Eckard, Forst, Burchardi (Hrsg.). Intensivmedizin. Landberg/Lech: Hüthig Jehle Rehm Verlagsgruppe 2006: 1-30
    Google Scholar
  • 13 Gibbs N, Gardner RM.. Dynamics of invasive pressure monitoring systems: clinical and laboratory evaluation.  Heart Lung. 1988;  17 43-51
    PubMedGoogle Scholar
  • 14 Gardner RM.. Direct blood pressure measurement: dynamic response requirements.  Anesthesiology. 1981;  54 227-236
    PubMedGoogle Scholar
  • 15 Kee L. et al. . Echocardiographic determination of valid zero reference levels in supine and lateral positions.  Am J Crit Care. 1993;  2 72-78
    PubMedGoogle Scholar
  • 16 Winsor T, Burch GE.. Phlebostatic axis and phlebostatic level: reference levels for venous pressure measurement in man.  Proc Soc Exp Biol Med. 1945;  58 165-169
    PubMedGoogle Scholar
  • 17 Bartz B. et al. . Differences in mid–anterioposterior level and midaxillary level in patients with a range of chest configurations.  Heart Lung. 1988;  17 308
    PubMedGoogle Scholar
  • 18 Gardner RM, Hujcs M.. Fundamentals of physiologic monitoring.  AACN Clin Issues. 1993;  4 11-24
    PubMedGoogle Scholar
  • 19 Martin C. et al. . Long–term arterial cannulation in ICU patients using the radial artery or dorsalis pedis artery.  Chest. 2001;  119 901-906
    CrossrefPubMedGoogle Scholar
  • 20 Sprung CL. et al. . Risk of right bundle–branch block and complete heart block during pulmonary artery catheterization.  Crit Care Med. 1989;  17 1-3
    PubMedGoogle Scholar
  • 21 Boyd KD. et al. . A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients.  Chest. 1983;  84 245-249
    CrossrefPubMedGoogle Scholar
  • 22 Kearney TJ, Shabot MM.. Pulmonary artery rupture associated with the Swan–Ganz catheter.  Chest. 1995;  108 1349-1352
    PubMedGoogle Scholar
  • 23 Marx G, Reinhart K.. Venous oximetry.  Curr Opin Crit Care. 2006;  12 263-268
    CrossrefPubMedGoogle Scholar
  • 24 Shoemaker WC. et al. . Hemodynamic patterns of survivors and nonsurvivors during high risk elective surgical operations.  World J Surg. 1999;  23 1264-1270
    CrossrefPubMedGoogle Scholar
  • 25 Della G Rocca. et al. . Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique.  Br J Anaesth. 2002;  88 350-356
    CrossrefPubMedGoogle Scholar
  • 26 Goedje O. et al. . Accuracy of beat–to–beat cardiac output monitoring by pulse contour analysis in hemodynamical unstable patients.  Med Sci Monit. 2001;  7 1344-1350
    PubMedGoogle Scholar
  • 27 Goedje O. et al. . Reliability of a new algorithm for continuous cardiac output determination by pulse–contour analysis during hemodynamic instability.  Crit Care Med. 2002;  30 52-58
    PubMedGoogle Scholar
  • 28 van Lieshout JJ, Wesseling KH.. Continuous cardiac output by pulse contour analysis?.  Br J Anaesth. 2001;  86 467-469
    PubMedGoogle Scholar
  • 29 Valtier B. et al. . Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler.  Am J Respir Crit Care Med. 1998;  158 77-83
    PubMedGoogle Scholar
  • 30 Laupland KB, Bands CJ.. Utility of esophageal Doppler as a minimally invasive hemodynamic monitor: a review.  Can J Anaesth. 2002;  49 393-401
    PubMedGoogle Scholar
  • 31 Van den Oever HL. et al. . USCOM (Ultrasonic Cardiac Output Monitors) lacks agreement with thermodilution cardiac output and transoesophageal echocardiography valve measurements.  Anaesth Intensive Care. 2007;  35 903-910
    PubMedGoogle Scholar
  • 32 Tan HL. et al. . Clinical evaluation of USCOM ultrasonic cardiac output monitor in cardiac surgical patients in intensive care unit.  Br J Anaesth. 2005;  94 287-291
    CrossrefPubMedGoogle Scholar
  • 33 Bloch KE.. Impedance and inductance monitoring of cardiac output. In: Tobin MJ, editor. Principles and practice of intensive care monitoring. New York: McGraw–Hill 1998: 915-930
    Google Scholar
  • 34 Yem JS. et al. . Sources of error in noninvasive pulmonary blood flow measurements by partial rebreathing: a computer model study.  Anesthesiology. 2003;  98 881-887
    CrossrefPubMedGoogle Scholar
  • 35 Neuhauser C. et al. . Partial CO2 rebreathing technique versus thermodilution measurement of cardiac output before and after operations with extracorporeal circulation.  Anaesthesist. 2002;  51 625-633
    PubMedGoogle Scholar
  • 36 Gama A. et al. . Performance of the partial CO2 rebreathing technique under different hemodynamic and ventilation/perfusion matching conditions.  Crit Care Med. 2003;  31 543-551
    CrossrefPubMedGoogle Scholar
  • 37 Tachibana K. et al. . Noninvasive cardiac output measurement using partial carbon dioxide rebreathing is less accurate at settings of reduced minute ventilation and when spontaneous breathing is present.  Anesthesiology. 2003;  98 830-837
    CrossrefPubMedGoogle Scholar
  • 38 Opdam HI. et al. . A pilot assessment of the FloTrac cardiac output monitoring system.  Intensive Care Med. 2007;  33 344-349
    CrossrefPubMedGoogle Scholar
  • 39 Breukers RM. et al. . Cardiac output measured by a new arterial pressure waveform analysis method without calibration compared with thermodilution after cardiac surgery.  J Cardiothorac Vasc Anesth. 2007;  21 632-635
    PubMedGoogle Scholar
  • 40 Mathew JP. et al. . ASE/SCA recommendations and guidelines for continuous quality improvement in perioperative echocardiography.  Anesth Analg. 2006;  103 1416-1425
    CrossrefPubMedGoogle Scholar
  • 41 Shanewise JS.. How to reliably detect ischemia in the intensive care unit and operating room.  Semin Cardiothorac Vasc Anesth. 2006;  10 101-109
    CrossrefPubMedGoogle Scholar
  • 42 Lichtwarck–Aschoff M. et al. . Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation.  Intensive Care Med. 1992;  18 142-147
    CrossrefPubMedGoogle Scholar
  • 43 Holm C. et al. . Intrathoracic blood volume as an end point in resuscitation of the severely burned: an observational study of 24 patients.  J Trauma. 2000;  48 728-734
    PubMedGoogle Scholar
  • 44 Michard F, Teboul JL.. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence.  Chest. 2002;  121 2000-2008
    CrossrefPubMedGoogle Scholar
  • 45 Bendjelid K, Romand JA.. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care.  Intensive Care Med. 2003;  29 352-360
    PubMedGoogle Scholar
  • 46 Reuter DA. et al. . Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function.  Crit Care Med. 2003;  31 1399-1404
    PubMedGoogle Scholar
  • 47 Rex S. et al. . Prediction of fluid responsiveness in patients during cardiac surgery.  Br J Anaesth. 2004;  93 782-788
    CrossrefPubMedGoogle Scholar
  • 48 Maizel J. et al. . Diagnosis of central hypovolemia by using passive leg raising.  Intensive Care Med. 2007;  33 1133-1138
    CrossrefPubMedGoogle Scholar
  • 49 Lamia al B et. Relationship between the tricuspid annular plane systolic excursion and right and left ventricular function in critically ill patients.  Intensive Care Med. 2007;  33 2143-2149
    CrossrefPubMedGoogle Scholar
  • 50 Lamia B. et al. . Contribution of arterial stiffness and stroke volume to peripheral pulse pressure in ICU patients: an arterial tonometry study.  Intensive Care Med. 2007;  33 1931-1937
    CrossrefPubMedGoogle Scholar
  • 51 Lamia B. et al. . Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity.  Intensive Care Med. 2007;  33 1125-1132
    CrossrefPubMedGoogle Scholar
  • 52 Monnet X. et al. . Passive leg raising predicts fluid responsiveness in the critically ill.  Crit Care Med. 2006;  34 1402-1407
    CrossrefPubMedGoogle Scholar
  • 53 Monnet X, Teboul JL.. Volume responsiveness.  Curr Opin Crit Care. 2007;  13 549-553
    CrossrefPubMedGoogle Scholar
  • 54 Monnet X, Teboul JL.. Invasive measures of left ventricular preload.  Curr Opin Crit Care. 2006;  12 235-240
    PubMedGoogle Scholar
  • 55 Sandham JD. et al. . A randomized, controlled trial of the use of pulmonary–artery catheters in high–risk surgical patients.  N Engl J Med. 2003;  348 5-14
    PubMedGoogle Scholar
  • 57 Graf J, Janssens U.. Evidenz–basierte Intensivmedizin: Praxis, Nutzen und Bedeutung.  Anaesthesist. 2004;  53 253-262
    CrossrefPubMedGoogle Scholar
  • 58 Janssens U, Graf J.. Was heißt EBM für die Klinik? In: Kuhlen R, Rossaint R, editors. Evidenzbasierte Medizin in Anästhesie und Intensivmedizin. Heidelberg: Springer 2006: 31-49
    Google Scholar
  • 59 Harvey S. et al. . Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC–Man): a randomised controlled trial.  Lancet. 2005;  366 472-477
    CrossrefPubMedGoogle Scholar
  • 60 Harvey S. et al. . An evaluation of the clinical and cost–effectiveness of pulmonary artery catheters in patient management in intensive care: a systematic review and a randomised controlled trial.  Health Technol Assess. 2006;  10 1-133
    PubMedGoogle Scholar
  • 61 Janssens U, Graf J.. Was ist "Schock"?.  Internist. 2004;  45 258-266
    CrossrefPubMedGoogle Scholar
  • 62 Graf J, Janssens U.. Monitoring. In: Madler, Jauch, Werdan, Sigrist, Pajonk, editors. Das Akutmedizin–Buch – Die ersten 24–Stunden. München: 1. Auflage Urban und Fischer Verlag 2005
    Google Scholar
  • 63 Graf J, Janssens U.. The early bird catches the worm.  Crit Care Med. 2005;  33 2412-2414
    CrossrefPubMedGoogle Scholar
  • 64 Bellomo R, Uchino S.. Cardiovascular monitoring tools: use and misuse.  Curr Opin Crit Care. 2003;  9 225-229
    CrossrefPubMedGoogle Scholar
  • 65 Nelson LD.. The new pulmonary artery catheters: continuous venous oximetry, right ventricular ejection fraction, and continuous cardiac output.  New Horiz. 1997;  5 251-258
    PubMedGoogle Scholar
  • 66 Diebel LN. et al. . End–diastolic volume. A better indicator of preload in the critically ill.  Arch Surg. 1992;  127 817-821
    CrossrefPubMedGoogle Scholar
  • 67 Pinsky MR.. Functional hemodynamic monitoring.  Intensive Care Med. 2002;  28 386-388
    CrossrefPubMedGoogle Scholar
  • 68 Reuter DA. et al. . Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery.  Intensive Care Med. 2002;  28 392-398
    CrossrefPubMedGoogle Scholar
  • 69 Eisenberg PR. et al. . Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients.  Crit Care Med. 1984;  12 549-553
    CrossrefPubMedGoogle Scholar
  • 70 Schlichtig R. et al. . Flow redistribution during progressive hemorrhage is a determinant of critical O2 delivery.  J Appl Physiol. 1991;  70 169-178
    PubMedGoogle Scholar
  • 71 Boldt J.. Clinical review: hemodynamic monitoring in the intensive care unit.  Crit Care. 2002;  6 52-59
    CrossrefPubMedGoogle Scholar
  • 72 Bellomo R, Pinsky MR.. Invasive hemodynamic monitoring. In: Tinker, Browne, Sibbald, editors. Critical Care: Standards, Audit and Ethics. New York: Oxford University Press 1996: 82-104
    Google Scholar
  • 73 Pinsky MR.. Pulmonary artery occlusion pressure.  Intensive Care Med. 2003;  29 19-22
    CrossrefPubMedGoogle Scholar
  • 74 Levy MM.. Pulmonary capillary pressure and tissue perfusion: clinical implications during resuscitation from shock.  New Horiz. 1996;  4 504-518
    PubMedGoogle Scholar

PD Dr. med. Jürgen Graf
Marc Irqsusi
Prof. Dr. med. Uwe Janssens

Email: jgraf@gmx.de

Email: uwe.janssens@sah-eschweiler.de

    Literaturverzeichnis
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