3. Solution

The aforementioned create a puzzle to solve each time a physician decides that hemodynamic monitoring is needed.

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 less reliable in cases of respiratory failure [2, 6], right ventricular failure or tricuspid regurgitation may compromise PAC derived measurement of CO [7], Doppler flow studies focusing on the descending thoracic aorta may not provide a reliable measurement of the total cardiac output (for example, with epidural use), and are invalid in the presence of intra-aortic balloon pumping [6]. CO measurements derived from peripheral arterial pressure waveform have shown luck of accuracy in patients with intracerebral hemorrhage [8], functional hemodynamic parameters like pulse pressure variation or stroke volume variation need regular sinus rhythm, etc.

As a consequence, several reports tried to suggest guidelines for hemodynamic monitoring in specific conditions, like for example, circulatory shock [9], sepsis [10], or patients under thoracic anesthesia [11].

Personalized hemodynamic monitoring concept emerges as the best available option. This is a very difficult task in most cases, as it assumes the existence of a dynamic close loop system with constantly new hemodynamic targets – adjusted to specific patient within a given clinical and time frame [12, 13].

Yet, even though we cannot form an individualized guideline, ongoing research, both clinical, experimental (including computational modeling of cardiovascular system and simulation of different pathological conditions) will help us create and clarify the exact theoretic concept which will direct the management. Along with that, formation of clear institutional policy about both the availability and the training of the personnel of each healthcare facility are needed, in order to standardize and regulate the use of certain medical devices over others (within the institution).
