Download PDF
Semin Respir Crit Care Med 2021; 42(01): 040-046
DOI: 10.1055/s-0040-1718387
Review Article

Noninvasive Monitoring in the Intensive Care Unit

Daniel De Backer
1   Department of Intensive Care, CHIREC Hospital, Université Libre de Bruxelles, Brussels, Belgium
,
Jean-Louis Vincent
2   Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

There has been considerable development in the field of noninvasive hemodynamic monitoring in recent years. Multiple devices have been proposed to assess blood pressure, cardiac output, and tissue perfusion. All have their own advantages and disadvantages and selection should be based on individual patient requirements and disease severity and adjusted according to ongoing patient evolution.

Keywords

microcirculation - pulse wave analysis - echocardiography - blood lactate


Publication History

Article published online:
16 October 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ait-Oufella H, Lemoinne S, Boelle PY. et al. Mottling score predicts survival in septic shock. Intensive Care Med 2011; 37 (05) 801-807
    CrossrefPubMedSearch in Google Scholar
  • 2 Bourcier S, Pichereau C, Boelle PY. et al. Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections. Ann Intensive Care 2016; 6 (01) 63
    CrossrefPubMedSearch in Google Scholar
  • 3 Lima A, van Genderen ME, van Bommel J, Klijn E, Jansem T, Bakker J. Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock. Crit Care 2014; 18 (03) R126
    CrossrefPubMedSearch in Google Scholar
  • 4 Hiemstra B, Eck RJ, Keus F, van der Horst ICC. Clinical examination for diagnosing circulatory shock. Curr Opin Crit Care 2017; 23 (04) 293-301
    CrossrefPubMedSearch in Google Scholar
  • 5 Ait-Oufella H, Bakker J. Understanding clinical signs of poor tissue perfusion during septic shock. Intensive Care Med 2016; 42 (12) 2070-2072
    CrossrefPubMedSearch in Google Scholar
  • 6 Hernández G, Cavalcanti AB, Ospina-Tascón G. et al; ANDROMEDA-SHOCK Study Investigators. Early goal-directed therapy using a physiological holistic view: the ANDROMEDA-SHOCK-a randomized controlled trial. Ann Intensive Care 2018; 8 (01) 52
    CrossrefPubMedSearch in Google Scholar
  • 7 Alsma J, van Saase JLCM, Nanayakkara PWB. et al; FAMOUS Study Group*. The power of flash mob research: conducting a nationwide observational clinical study on capillary refill time in a single day. Chest 2017; 151 (05) 1106-1113
    CrossrefPubMedSearch in Google Scholar
  • 8 Grissom CK, Morris AH, Lanken PN. et al; National Institutes of Health/National Heart, Lung and Blood Institute Acute Respiratory Distress. Association of physical examination with pulmonary artery catheter parameters in acute lung injury. Crit Care Med 2009; 37 (10) 2720-2726
    CrossrefPubMedSearch in Google Scholar
  • 9 Kazune S, Caica A, Volceka K, Suba O, Rubins U, Grabovskis A. Relationship of mottling score, skin microcirculatory perfusion indices and biomarkers of endothelial dysfunction in patients with septic shock: an observational study. Crit Care 2019; 23 (01) 311
    CrossrefPubMedSearch in Google Scholar
  • 10 De Backer D, Vieillard-Baron A. Clinical examination: a trigger but not a substitute for hemodynamic evaluation. Intensive Care Med 2019; 45 (02) 269-271
    CrossrefPubMedSearch in Google Scholar
  • 11 Pierrakos C, Velissaris D, Scolletta S, Heenen S, De Backer D, Vincent JL. Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock?. Intensive Care Med 2012; 38 (03) 422-428
    CrossrefPubMedSearch in Google Scholar
  • 12 Vincent JL, Nielsen ND, Shapiro NI. et al. Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database. Ann Intensive Care 2018; 8 (01) 107
    CrossrefPubMedSearch in Google Scholar
  • 13 Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki LM, Pettilä V. Hemodynamic variables related to outcome in septic shock. Intensive Care Med 2005; 31 (08) 1066-1071
    CrossrefPubMedSearch in Google Scholar
  • 14 Lamontagne F, Richards-Belle A, Thomas K. et al; 65 trial investigators. Effect of reduced exposure to vasopressors on 90-day mortality in older critically ill patients with vasodilatory hypotension: a randomized clinical trial. JAMA 2020; 323: 938-949
    CrossrefPubMedSearch in Google Scholar
  • 15 Asfar P, Meziani F, Hamel JF. et al; SEPSISPAM Investigators. High versus low blood-pressure target in patients with septic shock. N Engl J Med 2014; 370 (17) 1583-1593
    CrossrefPubMedSearch in Google Scholar
  • 16 Gershengorn HB, Stelfox HT, Niven DJ, Wunsch H. Association of premorbid blood pressure with vasopressor infusion duration in patients with shock. Am J Respir Crit Care Med 2020; 202 (01) 91-99
    CrossrefPubMedSearch in Google Scholar
  • 17 De Backer D, Teboul JL, Saugel B. Septic shock patients with adequate tissue perfusion parameters still need the recommended minimal mean arterial pressure: for sure. J Crit Care 2020; 56: 305-307
    CrossrefPubMedSearch in Google Scholar
  • 18 De Backer D, Foulon P. Minimizing catecholamines and optimizing perfusion. Crit Care 2019; 23 (Suppl. 01) 149
    CrossrefPubMedSearch in Google Scholar
  • 19 Marquez J, McCurry K, Severyn DA, Pinsky MR. Ability of pulse power, esophageal Doppler, and arterial pulse pressure to estimate rapid changes in stroke volume in humans. Crit Care Med 2008; 36 (11) 3001-3007
    CrossrefPubMedSearch in Google Scholar
  • 20 Michard F, Boussat S, Chemla D. et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000; 162 (01) 134-138
    CrossrefPubMedSearch in Google Scholar
  • 21 Cecconi M, De Backer D, Antonelli M. et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014; 40 (12) 1795-1815
    CrossrefPubMedSearch in Google Scholar
  • 22 Swan HJC, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 1970; 283 (09) 447-451
    CrossrefPubMedSearch in Google Scholar
  • 23 De Backer D, Vincent JL. The pulmonary artery catheter: is it still alive?. Curr Opin Crit Care 2018; 24 (03) 204-208
    CrossrefPubMedSearch in Google Scholar
  • 24 De Backer D, Bakker J, Cecconi M. et al. Alternatives to the Swan-Ganz catheter. Intensive Care Med 2018; 44 (06) 730-741
    CrossrefPubMedSearch in Google Scholar
  • 25 Monnet X, Vaquer S, Anguel N. et al. Comparison of pulse contour analysis by Pulsioflex and Vigileo to measure and track changes of cardiac output in critically ill patients. Br J Anaesth 2015; 114 (02) 235-243
    CrossrefPubMedSearch in Google Scholar
  • 26 Gopal S, Do T, Pooni JS, Martinelli G. Validation of cardiac output studies from the Mostcare compared to a pulmonary artery catheter in septic patients. Minerva Anestesiol 2014; 80 (03) 314-323
    PubMedSearch in Google Scholar
  • 27 Scheeren TW, Wiesenack C, Compton FD. et al. Performance of a minimally invasive cardiac output monitoring system (Flotrac/Vigileo). Br J Anaesth 2008; 101 (02) 279-280
    CrossrefPubMedSearch in Google Scholar
  • 28 Scolletta S, Franchi F, Romagnoli S. et al; Pulse wave analysis Cardiac Output validation (PulseCOval) Group. Comparison between Doppler-echocardiography and uncalibrated pulse contour method for cardiac output measurement: A multicenter observational study. Crit Care Med 2016; 44 (07) 1370-1379
    CrossrefPubMedSearch in Google Scholar
  • 29 De Backer D, Marx G, Tan A. et al. Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients. Intensive Care Med 2011; 37 (02) 233-240
    CrossrefPubMedSearch in Google Scholar
  • 30 Bendjelid K, Giraud R, Siegenthaler N, Michard F. Validation of a new transpulmonary thermodilution system to assess global end-diastolic volume and extravascular lung water. Crit Care 2010; 14 (06) R209
    CrossrefPubMedSearch in Google Scholar
  • 31 Monnet X, Persichini R, Ktari M, Jozwiak M, Richard C, Teboul JL. Precision of the transpulmonary thermodilution measurements. Crit Care 2011; 15 (04) R204
    CrossrefPubMedSearch in Google Scholar
  • 32 Cecconi M, Dawson D, Grounds RM, Rhodes A. Lithium dilution cardiac output measurement in the critically ill patient: determination of precision of the technique. Intensive Care Med 2009; 35 (03) 498-504
    CrossrefPubMedSearch in Google Scholar
  • 33 Hamzaoui O, Monnet X, Richard C, Osman D, Chemla D, Teboul JL. Effects of changes in vascular tone on the agreement between pulse contour and transpulmonary thermodilution cardiac output measurements within an up to 6-hour calibration-free period. Crit Care Med 2008; 36 (02) 434-440
    CrossrefPubMedSearch in Google Scholar
  • 34 Monnet X, Teboul JL. Transpulmonary thermodilution: advantages and limits. Crit Care 2017; 21 (01) 147
    CrossrefPubMedSearch in Google Scholar
  • 35 Teboul JL, Saugel B, Cecconi M. et al. Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med 2016; 42 (09) 1350-1359
    CrossrefPubMedSearch in Google Scholar
  • 36 Monnet X, Anguel N, Osman D, Hamzaoui O, Richard C, Teboul JL. Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Intensive Care Med 2007; 33 (03) 448-453
    CrossrefPubMedSearch in Google Scholar
  • 37 Fischer MO, Joosten A, Desebbe O. et al. Interchangeability of cardiac output measurements between non-invasive photoplethysmography and bolus thermodilution: A systematic review and individual patient data meta-analysis. Anaesth Crit Care Pain Med 2020; 39 (01) 75-85
    CrossrefPubMedSearch in Google Scholar
  • 38 Monnet X, Dres M, Ferré A. et al. Prediction of fluid responsiveness by a continuous non-invasive assessment of arterial pressure in critically ill patients: comparison with four other dynamic indices. Br J Anaesth 2012; 109 (03) 330-338
    CrossrefPubMedSearch in Google Scholar
  • 39 Squara P, Rotcajg D, Denjean D, Estagnasie P, Brusset A. Comparison of monitoring performance of Bioreactance vs. pulse contour during lung recruitment maneuvers. Crit Care 2009; 13 (04) R125
    CrossrefPubMedSearch in Google Scholar
  • 40 Marqué S, Cariou A, Chiche JD, Squara P. Comparison between Flotrac-Vigileo and Bioreactance, a totally noninvasive method for cardiac output monitoring. Crit Care 2009; 13 (03) R73
    CrossrefPubMedSearch in Google Scholar
  • 41 Fagnoul D, Vincent JL, Backer D. Cardiac output measurements using the bioreactance technique in critically ill patients. Crit Care 2012; 16 (06) 460
    CrossrefPubMedSearch in Google Scholar
  • 42 Douglas IS, Alapat PM, Corl KA. et al. Fluid response evaluation in sepsis hypotension and shock: a randomized clinical trial. Chest 2012; (e-pub ahead of print)
    CrossrefPubMedSearch in Google Scholar
  • 43 Mercado P, Maizel J, Beyls C. et al. Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient. Crit Care 2017; 21 (01) 136
    CrossrefPubMedSearch in Google Scholar
  • 44 De Backer D, Cholley BP, Slama M, Vieillard-Baron A, Vignon P. eds. Hemodynamic Monitoring Using Echocardiography in the Critically Ill. Heidelberg, Germany: Springer-Verlag; 2011
    CrossrefSearch in Google Scholar
  • 45 Wong A, Galarza L, Forni L. et al; ESICM Critical Care Ultrasound Group. Recommendations for core critical care ultrasound competencies as a part of specialist training in multidisciplinary intensive care: a framework proposed by the European Society of Intensive Care Medicine (ESICM). Crit Care 2020; 24 (01) 393
    CrossrefPubMedSearch in Google Scholar
  • 46 Atlas G, Brealey D, Dhar S, Dikta G, Singer M. Additional hemodynamic measurements with an esophageal Doppler monitor: a preliminary report of compliance, force, kinetic energy, and afterload in the clinical setting. J Clin Monit Comput 2012; 26 (06) 473-482
    CrossrefPubMedSearch in Google Scholar
  • 47 Mythen MG, Webb AR. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 1995; 130 (04) 423-429
    CrossrefPubMedSearch in Google Scholar
  • 48 Challand C, Struthers R, Sneyd JR. et al. Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery. Br J Anaesth 2012; 108 (01) 53-62
    CrossrefPubMedSearch in Google Scholar
  • 49 De Backer D. Detailing the cardiovascular profile in shock patients. Crit Care 2017; 21 (Suppl. 03) 311
    CrossrefPubMedSearch in Google Scholar
  • 50 Vincent JL, De Backer D. From early goal-directed therapy to late(r) Scvo2 checks. Chest 2018; 154 (06) 1267-1269
    CrossrefPubMedSearch in Google Scholar
  • 51 Rhodes A, Evans LE, Alhazzani W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017; 45 (03) 486-552
    CrossrefPubMedSearch in Google Scholar
  • 52 Monnet X, Rienzo M, Osman D. et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 2006; 34 (05) 1402-1407
    CrossrefPubMedSearch in Google Scholar
  • 53 De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 2005; 31 (04) 517-523
    CrossrefPubMedSearch in Google Scholar
  • 54 De Backer D, Pinsky MR. Can one predict fluid responsiveness in spontaneously breathing patients?. Intensive Care Med 2007; 33 (07) 1111-1113
    CrossrefPubMedSearch in Google Scholar
  • 55 Heenen S, De Backer D, Vincent JL. How can the response to volume expansion in patients with spontaneous respiratory movements be predicted?. Crit Care 2006; 10 (04) R102
    CrossrefPubMedSearch in Google Scholar
  • 56 Mahjoub Y, Pila C, Friggeri A. et al. Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle. Crit Care Med 2009; 37 (09) 2570-2575
    CrossrefPubMedSearch in Google Scholar
  • 57 De Backer D, Vincent JL. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Crit Care 2018; 22 (01) 43
    CrossrefPubMedSearch in Google Scholar
  • 58 Biais M, Ehrmann S, Mari A. et al; AzuRea Group. Clinical relevance of pulse pressure variations for predicting fluid responsiveness in mechanically ventilated intensive care unit patients: the grey zone approach. Crit Care 2014; 18 (06) 587
    CrossrefPubMedSearch in Google Scholar
  • 59 Eskesen TG, Wetterslev M, Perner A. Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness. Intensive Care Med 2016; 42 (03) 324-332
    CrossrefPubMedSearch in Google Scholar
  • 60 Vincent JL, Weil MH. Fluid challenge revisited. Crit Care Med 2006; 34 (05) 1333-1337
    CrossrefPubMedSearch in Google Scholar
  • 61 Cecconi M, Hofer C, Teboul JL. et al; FENICE Investigators, ESICM Trial Group. Fluid challenges in intensive care: the FENICE study: a global inception cohort study. Intensive Care Med 2015; 41 (09) 1529-1537
    CrossrefPubMedSearch in Google Scholar
  • 62 Hamzaoui O, Gouëzel C, Jozwiak M. et al. Increase in central venous pressure during passive leg raising cannot detect preload unresponsiveness. Crit Care Med 2020; 48 (08) e684-e689
    CrossrefPubMedSearch in Google Scholar
  • 63 De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 2002; 166 (01) 98-104
    CrossrefPubMedSearch in Google Scholar
  • 64 De Backer D, Donadello K, Sakr Y. et al. Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med 2013; 41 (03) 791-799
    CrossrefPubMedSearch in Google Scholar
  • 65 Spanos A, Jhanji S, Vivian-Smith A, Harris T, Pearse RM. Early microvascular changes in sepsis and severe sepsis. Shock 2010; 33 (04) 387-391
    CrossrefPubMedSearch in Google Scholar
  • 66 Spronk PE, Ince C, Gardien MJ, Mathura KR, Oudemans-van Straaten HM, Zandstra DF. Nitroglycerin in septic shock after intravascular volume resuscitation. Lancet 2002; 360 (9343): 1395-1396
    CrossrefPubMedSearch in Google Scholar
  • 67 Trzeciak S, McCoy JV, Phillip Dellinger R. et al; Microcirculatory Alterations in Resuscitation and Shock (MARS) investigators. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med 2008; 34 (12) 2210-2217
    CrossrefPubMedSearch in Google Scholar
  • 68 De Backer D, Creteur J, Dubois MJ, Sakr Y, Vincent JL. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 2004; 147 (01) 91-99
    CrossrefPubMedSearch in Google Scholar
  • 69 den Uil CA, Lagrand WK, van der Ent M. et al. Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 2010; 31 (24) 3032-3039
    CrossrefPubMedSearch in Google Scholar
  • 70 Tachon G, Harrois A, Tanaka S. et al. Microcirculatory alterations in traumatic hemorrhagic shock. Crit Care Med 2014; 42 (06) 1433-1441
    CrossrefPubMedSearch in Google Scholar
  • 71 Jhanji S, Lee C, Watson D, Hinds C, Pearse RM. Microvascular flow and tissue oxygenation after major abdominal surgery: association with post-operative complications. Intensive Care Med 2009; 35 (04) 671-677
    CrossrefPubMedSearch in Google Scholar
  • 72 Ospina-Tascón GA, Nieto Calvache AJ, Quiñones E. et al. Microcirculatory blood flow derangements during severe preeclampsia and HELLP syndrome. Pregnancy Hypertens 2017; 10: 124-130
    CrossrefPubMedSearch in Google Scholar
  • 73 Tanaka S, Harrois A, Nicolaï C. et al. Qualitative real-time analysis by nurses of sublingual microcirculation in intensive care unit: the MICRONURSE study. Crit Care 2015; 19: 388
    CrossrefPubMedSearch in Google Scholar