Monitorización hemodinámica: de la fisiólogia a la monitorización.
DOI:
https://doi.org/10.30445/rear.v12i1.787Palabras clave:
Presión media sistémica de llenado (Psmf-PMS), Gasto cardiaco, Ecocardiografía, Elastancia arterial, Retorno venoso, Monitorización, HemodinámicaResumen
Para la comprensión del paciente hemodinámicamente inestable y su tratamiento se requiere un conocimiento de la propia fisiología cardiovascular y los métodos de monitorización hemodinámica disponibles. En esta revisión se debatirá el papel de la circulación sanguínea tanto venosa como arterial y la monitorización del gasto cardiaco, en especial mediante ecocardiografía. La revisión se estructura en los apartados siguientes: la fisiología venosa, la arterial y la monitorización hemodinámica.
Es necesario incluir conceptos ya conocidos como la presión media sístemica de llenado (PMS) y la elastancia (E) tanto aortica como dinámica para poder evaluar la respuesta a la administración de fluidos. En un futuro próximo los algoritmos de los monitores hemodinámicos incluirán estas variables y otras muchas que nos proporcionaran una herramienta muy útil para el manejo del paciente hemodinámicamente inestable.
Citas
- Patterson SW, Starling EH. On the mechanical factors which determine the output of the ventricles. J Physiol 1914;48:357-79.
- Guyton AC. Regulation of cardiac output. Anesthesiology 1968;29:314-26.
- Henderson WR, Griesdale DE, Walley KR and Sheelet AW. Guyton: the role of mean circulatory filling pressure and right atrial pressure in controlling cardiac output. Critical Care 2010;14:243.
- Rothe CF. Reflex control of veins and vascular capacitance. Physiol Rev 1983; 63:1281–1342.
- Ripollés-Melchor J, Chappell D, Aya HD, et al Recomendaciones de fluidoterapia perioperatoria para la cirugía abdominal mayor. Revisión de las recomendaciones de la Vía RICA. Parte II: Terapia hemodinámica guiada por objetivos. Fundamento para la optimización del volumen intravascular. Rev Esp Anestesiol Reanim 2017;64:339-47
- Anderson RM. The gross physiology of the cardiovascular system. 2012 ed. Tucson, Arizona: Racquet Press; 1993.
- Maas JJ, ; Pinsky MR; Aarts LP ;. Janse JR. Bedside Assessment of Total Systemic Vascular Compliance, Stressed Volume, and Cardiac Function Curves in Intensive Care Unit Patients. Anesth Analg 2012; 115:880 –7.
- Parkin, W.G. & Leaning, M.S. J Clin Monit Comput 2008, 22: 391. https://doi.org/10.1007/s10877-008-9147-7.
- He, H., Gruartmoner, G., Ince, Y., van Berge Henegouwen, M., Gisbertz, S., Geerts, B., Ince, C., Hollmann, M., Liu, D., Veelo, D. Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy. Journal of Thoracic Disease, 2018, 10 (6): 3399-3408.
- Maas JJ, Geerts BF, van den Berg PCM, Pinsky MR, Jansen JRC: Assessment of venous return curve and mean systemic filling pressure in postoperative cardiac surgery patients. Crit Care Med 2009, 37:912-918.
- Maas JJ, de Wilde RB, Aarts LP, Pinsky MR, Jansen JR. Determination of vascular waterfall phenomenon by bedside measurement of mean systemic filling pressure and critical closing pressure in the intensive care unit. Anesth Analg. 2012;114(4):803-10.
- Morelli, A. & De Backer, D. The ten principles behind arterial pressure. Intensive Care Med (2018) 44: 911-15.
- Kottenberg-Assenmacher E, Aleksic I, Eckholt M, Lehmann N, Peters j; Critical Closing Pressure as the Arterial Downstream Pressure with the Heart Beating and during Circulatory Arrest. Anesthesiology 2009;110 (2):370-379.
- Du W, Liu D, Long Y and Wang X. The β-Blocker Esmolol Restores the Vascular Waterfall Phenomenon After Acute Endotoxemia. Critical Care Medicine, Volume 45, Number 12, December 2017, pp. e1247-e1253(7).
- Magder S. The meaning of blood pressure. Critical Care (2018) 22:257-67.
- Ochagavía A., Zapata L., Carrillo A., Rodríguez A., Guerrero M., Ayuela J.M.. Evaluación de la contractilidad y la poscarga en la unidad de cuidados intensivos. Med Intensiva 2012: Jul ; 36( 5): 365-374.
- Monge García MI, Gil Cano A, Gracia Romero M. Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients. Crit Care. 2011;15(1):R15.
- Monge García, M. I., Guijo González, P., Gracia Romero, M., Gil Cano, A., Oscier, C., Rhodes, A., Cecconi, M. (2015). Effects of fluid administration on arterial load in septic shock patients. Intensive Care Medicine, 41(7), 1247–1255.
- Chantler PD, Lakatta EG, Najjar SS. Arterial-ventricular coupling: mechanistic insights into cardiovascular performance at rest and during exercise. J Appl Physiol (1985). 2008;105(4):1342-51.
- Tovar Doncel MS. Visualizando más allá de la macrohemodinamia https://anestesiar.org/2017/visualizando-mas-alla-la-macrohemodinamia/. Last access Enero 2019.
- Barrachina B, Cobos R, Mardones N, Castan A and Vinuesa C. Assessment of a smartphone app (Capstesia) for measuring pulse pressure variation: agreement between two methods.A Cross-sectional study. Eur J Anaesthesiol 2016;33:1–6.
- Bentzer P, Griesdale DE, Boyd J, MacLean K, Sirounis D, Ayas NT. Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids? JAMA. 2016;316(12):1298–1309.
- Cecconi, M., Hofer, C., Teboul, JL. et al. Fluid challenges in intensive care: the FENICE study. Intensive Care Med 20151; 41: 1529.
- Charbonneau H, Riu B, Faron M, Mari A, Kurrek MM, Ruiz J, et al. Predicting preload responsiveness using simultaneous recordings of inferior and superior vena cavae diameters. Crit Care. 2014;18:473.
- Orso, D., Paoli, I., Piani, T., Cilenti, F. L., Cristiani, L., & Guglielmo, N. (2018). Accuracy of Ultrasonographic Measurements of Inferior Vena Cava to Determine Fluid Responsiveness: A Systematic Review and Meta-Analysis. Journal of Intensive Care Medicine, 088506661775230. doi:10.1177/0885066617752308
- Via, G., Tavazzi, G., & Price, S. (2016). Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: a physiologically based point of view. Intensive Care Medicine, 42(7), 1164–1167.
- Ochagavía A, Baigorri F, Mesquida J, Ayuela JM, Ferrándiz A, García X, Monge MI, Grupo de Trabajo de Cuidados Intensivos Cardiológicos y RCP de la SEMICYUC. Hemodynamic monitoring in the critically patient. Recomendations of the Cardiological Intensive Care and CPR Working Group of the Spanish Society of Intensive Care and Coronary Units. Med Intensiva Vol. 38. Núm. 3. 2014 : 133-200.
- In Critical and Acute Care Ultrasound: A Comprehensive Book on Critical and Acute Care Ultrasound (CACU), edited by Manu Malbrain. Chapter 9 (pag 109) CGuy L.J. Vermeiren, Manu L.N.G. Malbrain, Jeroen M.J.B. Walpot. Cardiac Ultrasonography in the critical care setting: a practical approach to assess the cardiac function and preload for the “non – cardiologist”. ©2017 International Fluid Academy.
- Guyton AC. Regulation of cardiac output. Anesthesiology 1968;29:314-26.
- Henderson WR, Griesdale DE, Walley KR and Sheelet AW. Guyton: the role of mean circulatory filling pressure and right atrial pressure in controlling cardiac output. Critical Care 2010;14:243.
- Rothe CF. Reflex control of veins and vascular capacitance. Physiol Rev 1983; 63:1281–1342.
- Ripollés-Melchor J, Chappell D, Aya HD, et al Recomendaciones de fluidoterapia perioperatoria para la cirugía abdominal mayor. Revisión de las recomendaciones de la Vía RICA. Parte II: Terapia hemodinámica guiada por objetivos. Fundamento para la optimización del volumen intravascular. Rev Esp Anestesiol Reanim 2017;64:339-47
- Anderson RM. The gross physiology of the cardiovascular system. 2012 ed. Tucson, Arizona: Racquet Press; 1993.
- Maas JJ, ; Pinsky MR; Aarts LP ;. Janse JR. Bedside Assessment of Total Systemic Vascular Compliance, Stressed Volume, and Cardiac Function Curves in Intensive Care Unit Patients. Anesth Analg 2012; 115:880 –7.
- Parkin, W.G. & Leaning, M.S. J Clin Monit Comput 2008, 22: 391. https://doi.org/10.1007/s10877-008-9147-7.
- He, H., Gruartmoner, G., Ince, Y., van Berge Henegouwen, M., Gisbertz, S., Geerts, B., Ince, C., Hollmann, M., Liu, D., Veelo, D. Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy. Journal of Thoracic Disease, 2018, 10 (6): 3399-3408.
- Maas JJ, Geerts BF, van den Berg PCM, Pinsky MR, Jansen JRC: Assessment of venous return curve and mean systemic filling pressure in postoperative cardiac surgery patients. Crit Care Med 2009, 37:912-918.
- Maas JJ, de Wilde RB, Aarts LP, Pinsky MR, Jansen JR. Determination of vascular waterfall phenomenon by bedside measurement of mean systemic filling pressure and critical closing pressure in the intensive care unit. Anesth Analg. 2012;114(4):803-10.
- Morelli, A. & De Backer, D. The ten principles behind arterial pressure. Intensive Care Med (2018) 44: 911-15.
- Kottenberg-Assenmacher E, Aleksic I, Eckholt M, Lehmann N, Peters j; Critical Closing Pressure as the Arterial Downstream Pressure with the Heart Beating and during Circulatory Arrest. Anesthesiology 2009;110 (2):370-379.
- Du W, Liu D, Long Y and Wang X. The β-Blocker Esmolol Restores the Vascular Waterfall Phenomenon After Acute Endotoxemia. Critical Care Medicine, Volume 45, Number 12, December 2017, pp. e1247-e1253(7).
- Magder S. The meaning of blood pressure. Critical Care (2018) 22:257-67.
- Ochagavía A., Zapata L., Carrillo A., Rodríguez A., Guerrero M., Ayuela J.M.. Evaluación de la contractilidad y la poscarga en la unidad de cuidados intensivos. Med Intensiva 2012: Jul ; 36( 5): 365-374.
- Monge García MI, Gil Cano A, Gracia Romero M. Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients. Crit Care. 2011;15(1):R15.
- Monge García, M. I., Guijo González, P., Gracia Romero, M., Gil Cano, A., Oscier, C., Rhodes, A., Cecconi, M. (2015). Effects of fluid administration on arterial load in septic shock patients. Intensive Care Medicine, 41(7), 1247–1255.
- Chantler PD, Lakatta EG, Najjar SS. Arterial-ventricular coupling: mechanistic insights into cardiovascular performance at rest and during exercise. J Appl Physiol (1985). 2008;105(4):1342-51.
- Tovar Doncel MS. Visualizando más allá de la macrohemodinamia https://anestesiar.org/2017/visualizando-mas-alla-la-macrohemodinamia/. Last access Enero 2019.
- Barrachina B, Cobos R, Mardones N, Castan A and Vinuesa C. Assessment of a smartphone app (Capstesia) for measuring pulse pressure variation: agreement between two methods.A Cross-sectional study. Eur J Anaesthesiol 2016;33:1–6.
- Bentzer P, Griesdale DE, Boyd J, MacLean K, Sirounis D, Ayas NT. Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids? JAMA. 2016;316(12):1298–1309.
- Cecconi, M., Hofer, C., Teboul, JL. et al. Fluid challenges in intensive care: the FENICE study. Intensive Care Med 20151; 41: 1529.
- Charbonneau H, Riu B, Faron M, Mari A, Kurrek MM, Ruiz J, et al. Predicting preload responsiveness using simultaneous recordings of inferior and superior vena cavae diameters. Crit Care. 2014;18:473.
- Orso, D., Paoli, I., Piani, T., Cilenti, F. L., Cristiani, L., & Guglielmo, N. (2018). Accuracy of Ultrasonographic Measurements of Inferior Vena Cava to Determine Fluid Responsiveness: A Systematic Review and Meta-Analysis. Journal of Intensive Care Medicine, 088506661775230. doi:10.1177/0885066617752308
- Via, G., Tavazzi, G., & Price, S. (2016). Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: a physiologically based point of view. Intensive Care Medicine, 42(7), 1164–1167.
- Ochagavía A, Baigorri F, Mesquida J, Ayuela JM, Ferrándiz A, García X, Monge MI, Grupo de Trabajo de Cuidados Intensivos Cardiológicos y RCP de la SEMICYUC. Hemodynamic monitoring in the critically patient. Recomendations of the Cardiological Intensive Care and CPR Working Group of the Spanish Society of Intensive Care and Coronary Units. Med Intensiva Vol. 38. Núm. 3. 2014 : 133-200.
- In Critical and Acute Care Ultrasound: A Comprehensive Book on Critical and Acute Care Ultrasound (CACU), edited by Manu Malbrain. Chapter 9 (pag 109) CGuy L.J. Vermeiren, Manu L.N.G. Malbrain, Jeroen M.J.B. Walpot. Cardiac Ultrasonography in the critical care setting: a practical approach to assess the cardiac function and preload for the “non – cardiologist”. ©2017 International Fluid Academy.
Descargas
Publicado
2020-09-10
Cómo citar
Llagunes Herrero, J. (2020). Monitorización hemodinámica: de la fisiólogia a la monitorización. Revista Electrónica AnestesiaR, 12(1), 4. https://doi.org/10.30445/rear.v12i1.787
Número
Sección
Artículos de revisión
Licencia
Derechos de autor 2020 Revista Electrónica AnestesiaR
Esta obra está bajo una licencia internacional Creative Commons Atribución-CompartirIgual 4.0.
Envío y derechos de autor
Revista Electrónica AnestesiaR by 