Cardiac failure leads to a reduction in oxygen delivery resulting in tissue hypoperfusion, multi-organ dysfunction (MODS) and multi-organ failure (MOF). There can be many causes for cardiac failure, including ischaemia and myocardial infarction, arrhythmias, myocarditis, valvopathies and idiopathic cardiomyopathies.
Left ventricular systolic insufficiency, is characterized by a reduction in contractility resulting in a reduction in stroke volume, arterial hypotension and an increase in filling pressures (LVEDP and CVP). The clinical consequences may be pulmonary oedema, venous stasis and increased afterload as a compensatory mechanism. Also, poor cardiac contractility may be accompanied by unsuccessful weaning from mechanical ventilation and organ hypoperfusion. These comorbidities are responsible for a prolonged stay in intensive care.
Whilst echocardiography allows us to diagnose the nature of heart failure, it does require experience, is not always instantly available and is not designed for continuous monitoring.
Continuous hemodynamic monitoring has the advantage of allowing the clinician to obtain information on the cardiovascular status of the patient on a continuous basis and thus facilitating control of the effectiveness of therapy over time; using trending variables, thereby reducing the risk of a deterioration in the patient clinical condition.
Img. 5 – A typical example of hemodynamic monitoring-based therapy
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