Invasive Intravascular Hemodynamic Monitoring: Technical Issues

Sheldon Magder, MD, FRCP(C)

McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1

Hemodynamics measurements are a fundamental part of the management of critically ill patients. Many millions of dollars are spent on equipment to make these measurements, and many hours are spent arguing over the appropriate algorithms for their use at the bedside. Despite the obvious fact that these measurements can only be useful if they are valid and accurate, studies repeatedly show that there is a lack of knowledge of the basic principles behind these measurements and the important artifacts that can result in unreliable measurements [1,2]. This is especially a problem for measurements of central venous pressure (CVP) and pulmonary artery occlusion pressure (Ppao), because the range of normal clinical values is small and errors can become a large percentage of the true value. In this article, the author reviews the basic principles of making hemodynamic measurements as well as common artifacts and pitfalls.

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