invasive intravascular hemodynamic monitoring - technical issues

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Invasive Intravascular Hemodynamic Monitoring: Technical Issues Sheldon Magder, MD, FRCP(C) McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1 Hemodynamics measurements are a fun dament al par t of the man age - ment of critically ill patients. Many millions of dollars are spent on equip- me nt to make thes e me asurements, and many ho urs are spent argui ng over the appropriate algorithms for their use at the bedside. Despite the obvious fact that these measurements can only be useful if they are valid and accurate, studies repeatedly show that there is a lack of knowledge of the basic principles behind these measurements and the important artifacts that can result in unreliable measurements [1,2]. This is especially a problem for measurements of central venous pressure (CVP) and pulmonary artery occlusion pressure (Ppao), because the range of normal clinical values is small and errors can become a large percentage of the true value. In this art icl e, the author reviews the bas ic pri nc ipl es of mak ing hemodynamic measurements as well as common artifacts and pitfalls. What is pressure? Pressure is force per cross-se cti onal area. As de sc rib ed in Newton’s second law, force is the product of mass and acceleration, and the force is measured as a vector, that is, in a straight line in a given direction. In bio- logic systems, forces usually need to be assessed over the surfaces of curved structures, such as vessels and the heart. To deal with this problem, force is anal yz ed as pressure, whic h is force pe r cross-se cti onal area. Pressures are measured most often in units of millimeters of mercury (mm Hg) and centimeters of water (cm H 2 O). When these units are used, the applied force is gravity and the acceleration is the gravitational constant. The force is then related to the mass of ﬂuid used for the measurement, which, in turn, is E-mail address: [email protected] 0749-0704/07/$ - see front matter Ó 2007 Elsevier Inc. All rights reserved. Crit Care Clin 23 (2007) 401–414

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