Haret C.O., Grib L.T.
HEMODYNAMIC MONITORING IN CARDIOGENIC SHOCK *
Аннотация:
This article has the aim to describe the main methods of hemodynamic monitoring in cardiogenic shock highlighting their advantages and disadvantages
Ключевые слова:
cardiogenic shock, hemodynamic monitoring
Cardiogenic shock (CS) is a clinical state with decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume [9, p. 1]. CS is a severe and lifethreatening state with the mortality up to 80 % [4, p. 1]. Even though the mortality has decreased to 50 %, due to the development of the monitoring systems and the improvement of guidelines, it continues to be the main cause of death in patients with acute myocardial infarction [7, p. 1]. Considering the complexity of hemodynamic impairment that occurs in cardiagenic shock, it is vital to fully understand its physiopathology and compensatory mechanisms in order to select the corresponding medical treatment [8, p. 40]. A multitude of studies had the goal to analyze the abilities of the clinicians to appreciate the hemodynamic state of the patients, using only the physical examination. The rate of successful diagnosis was up to 60%, but the majority of clinicians have switched the treatment after the performance of the invasive or mini-invasive monitoring. These results have shown the necessity of a hemodynamic monitoring device that will be able to give a more precise guidance in the management of CS [3, p. 295]. The main monitoring systems widely used in practice are: the echocardiography, the pulmonary artery catheter, LiDCO System and PiCCO System. The EchoCG is one of the most used monitoring systems which allows to determine the structural particularities of the heart and helps to establish the etiologic diagnosis. It can also give you a hint about the heart’s preload, judging by the diameter of the inferior vena cava. The disadvantages of the method are: the discontinuity of monitoring, the examiner dependence and also the high cost [1, p. 631]. The pulmonary artery catheter is another widely used monitoring system that is used over 30 years. Its benefit has been recently questioned because of its invasiveness. The LiDCO System is based on the dilution of the lithium in the organism. The lithium is inoculated in a central vein and a sensor is installed in a peripheral artery. The sensor will determine the concentration of the lithium in the blood, as well as the hemodynamic parameters depending on the timing and its concentration in the blood. The amount of the parameters calculated is bigger than the previously, listed, methods [2, p. 368]. And finally the PiCCO System which is also based on a dilution method but uses the temperature instead. It is crucial to use liquid that is at least 12 degree lower than the blood temperature. PiCCO calculates all the parameters using two methods the transpulmonary thermodilution and the pulse contour analysis. PiCCO is better than the other systems because it is less invasive, has the possibility of continuous dynamic monitoring, the system may be maintained up to 10 days and the price is relatively low [5, p. 395]. Cardiogenic shock continues to be an important cause of potentially reversible morbidity and mortality in hospitalized patients. The ability to correctly diagnose as well as monitor the efficacy of the treatment and correct it in time, is crucial for improving outcomes. Currently there isn’t a perfect type of monitoring, each of them having their own advantages and disadvantages [6, p. 230].
Номер журнала Вестник науки №5 (14) том 3
Ссылка для цитирования:
Haret C.O., Grib L.T. HEMODYNAMIC MONITORING IN CARDIOGENIC SHOCK // Вестник науки №5 (14) том 3. С. 393 - 395. 2019 г. ISSN 2712-8849 // Электронный ресурс: https://www.вестник-науки.рф/article/1340 (дата обращения: 25.04.2024 г.)
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