Assessment of cardiac function and circulatory status in critically ill patients
Abstract
Background: Assessment of cardiac function and circulation is mandatory in almost all critically ill patients. In many patients morphological diagnosis of actual or pre-existing cardiac diseases and their functional consequences should be obtained.
Methods: Cardiac function can be assessed by various non-invasive and invasive methods. The value of every method should be assessed according to its ability and reliability to assess preload, cardiac output and the adequacy of flow. In hemodinamically unstable patients frequent reassessment must be performed, because of rapid changes of patients’ conditions. Therefore, all methods for hemodynamic assessment in the ICU must be available on the 24 hours basis. Combined non-invasive and invasive approach to the assessment of cardiac function and circulation is preferred. After initial assessment of cardiac function according to clinical examination, electrocardiogram, chest X-ray and blood gas analysis, echocardiography is routinely used. When continuous monitoring of cardiac function is mandatory, complete invasive monitoring with pulmonary artery catheter and arterial line is employed. Monitoring of pulmonary pressures, continuous cardiac output, mixed venous blood oxygen saturation, and parameters of right ventricular function is the best choice to obtain complete information of hemodynamic situation. In patients with increased pulmonary vascular permeability the monitoring of cardiac output by pulse contour method together with measurement of intrathoracic blood volume and extravascular lung water could be even better choice.
Conclusions: Assessment of cardiac function and circulatory status by rational use of various non-invasive and invasive methods is one of the essential components of critical care management.
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References
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