Conflict of interests

3. There are no optimal hemodynamic parameters for every patient.

devices, the future seems to belong to non-invasive techniques.

Chan and Khan [3] reviewed the problem from a more physiological point of view. They claimed that since there is no hemodynamic monitoring that can provide us data for the "whole" cardiovascular system and that the main role of the latter is oxygen delivery, we need to choose our monitoring according to the target part of the cardiovascular system and to aim at correlation of the data with oxygen delivery. Thus, we might have a better connection

Another issue brought up by Peter et al. [4, 5], is calibration. There are calibrated and noncalibrated techniques for hemodynamic monitoring. Though calibrated (invasive in the majority of them) methods seem to work better in unstable patients, careful interpretation of the provided data is needed. On the other hand, as new technology is integrated in medical

And what about continuity of data and of care? For example, pulmonary artery catheter (PAC), which triggered a boom in hemodynamic monitoring, provides only static variables. A snapshot of patient's status, often not enough to determine the right therapeutic strategy. Along with that if the same patient is admitted to Emergency Department with an A hemodynamic profile derived from arterial pressure wave, transported to ward where he had a B profile measured via suprasternal Doppler and ended in ICU where PAC and bio-impedance measurements are available, do we take in mind the previous profiles (A and B) or not? One option is to reject previous measurements, thus risking loosing valuable data. Another option is to just average

measurements. However, plans based on average assumptions, are on average wrong.

The latter is even more valid for the therapeutic strategy that we may choose. If a drug causes on average an increase in cardiac output (CO), how do we know that our patient lies within

The previous problem is perplexed by the fact that different modes of monitoring may provide us with different variables. CO may be a common parameter for various devices, yet extra lung water index, oxygen extraction ration, wedge pulmonary pressure, peak velocity and Doppler

The aforementioned create a puzzle to solve each time a physician decides that hemodynamic

Monitoring that combines conditions and advantages of each monitoring technique could be a solution to the problem. Thus, for example CO based on partial CO2 rebreathing is considered

4. We need to combine and integrate variables. 5. Continuous measurements are preferable. 6. Non-invasiveness is not the only issue.

7. Cardiac output is estimated not measured.

between monitoring and outcome.

4 Highlights on Hemodynamics

this average?

3. Solution

monitoring is needed.

driven dp/dt may be harder to combine.

The author has no conflict of interest.
