Using arterial pressure waveform analysis for the assessment of fluid responsiveness

Abstract

Predicting the effects of volume expansion on cardiac output and oxygen delivery is of major importance in different clinical scenarios. Functional hemodynamic parameters based on pulse waveform analysis, which are relying on the effects of mechanical ventilation on stroke volume and its surrogates, have been shown to be reliable predictors of fluid responsiveness during anesthesia and intensive care unit treatment, as demonstrated by several clinical studies and meta-analyses. However, different limitations of these parameters have to be considered when they are used in clinical practice. Today, they can be continuously and automatically monitored by a variety of commercially available devices. These parameters have been introduced into the concept of perioperative fluid management and hemodynamic optimization – an approach that may positively impact postoperative patients’ outcomes. In this article, technical aspects of the assessment of the functional hemodynamic parameters derived from pulse waveform analysis are summarized, emphasizing their advantages, limitations and potential applications, primarily in a perioperative setting in order to improve patient outcome.

Keywords::

• arterial wave form analysis
• fluid responsiveness
• functional hemodynamic parameter

Acknowledgements

The authors wish to thank Brenton Alexander for English editing.

Financial & competing interests disclosure

This review was written without any financial support from manufacturers or the pharmaceutical industries. Maxime Cannesson has received research grants, consulting or lecturing fees from CNSystems, Conmed Corp., Covidien, Edwards LifeSciences, Fresenius Kabi, Masimo Corp. and Philips. Daniel de Backer is on the speakers’ bureau for Edwards Lifesciences and Pulsion and has received material/grants for studies from Edwards Lifesciences, Vytech and LiDCO. Christoph K Hofer has received funding from Pulsion Medical Systems, Edwards LifeSciences and CSL Behring. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.