[Application of non-invasive hemodynamic monitoring on high-risk surgical patients in the early stages after emergency admission].
OBJECTIVE: Pulmonary artery (PA) catheterization monitoring (Swan-Ganz) is usually not available to critically high-risk surgical patients before admission to ICU, where action to correct values derived from such monitoring may be too late. To explored the effect of non-invasive monitoring systems that allow hemodynamic monitoring during the early stages after trauma. METHODS: The early temporal hemodynamic patterns after high-risk trauma with non-invasive monitoring systems were evaluated, and compared these to invasive PA monitoring. The study included 156 patients monitored shortly after admission to the emergency department. RESULTS: The non-invasive impedance cardiac output estimations under extenuating emergency conditions were similar to those of the thermodilution method: r=0.69, r(2)=0.87, P<0.001; bias and precision were (0.62+/-0.38)L. min(-1).m(-2). In ICU, these values improved further to: r=0.84, r(2)=0.93, P<0.001; bias and precision were (0.36+/-0.15) L.min(-1).m(-2). Monitoring revealed episodes of hypotension, low cardiac index, arterial hemoglobin desaturation, low transcutaneous oxygen and high transcutaneous carbon dioxide tension, and low oxygen consumption during initial resuscitation. Low flow and poor tissue perfusion were more pronounced in non-survivors by both METHODS. CONCLUSION: Multicomponent non-invasive monitoring systems offer continuous on-line, real-time display of hemodynamic data, they allow early recognition of circulatory dysfunction. Such systems provide information similar to that provided by the invasive thermodilution method, and are more effective and safer.