Non-invasive hemodynamic monitoring in trauma patients
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WORLD JOURNAL OF EMERGENCY SURGERY
REVIEW
Open Access
Non-invasive hemodynamic monitoring in trauma patients Matthias Kuster1, Aristomenis Exadaktylos2 and Beat Schnüriger1,3*
Abstract Background: The assessment of hemodynamic status is a crucial task in the initial evaluation of trauma patients. However, blood pressure and heart rate are often misleading, as multiple variables may impact these conventional parameters. More reliable methods such as pulmonary artery thermodilution for cardiac output measuring would be necessary, but its applicability in the Emergency Department is questionable due to their invasive nature. Non-invasive cardiac output monitoring devices may be a feasible alternative. Methods: A systematic literature review was conducted. Only studies that explicitly investigated non-invasive hemodynamic monitoring devices in trauma patients were considered. Results: A total of 7 studies were identified as suitable and were included into this review. These studies evaluated in a total of 1,197 trauma patients the accuracy of non-invasive hemodynamic monitoring devices by comparing measurements to pulmonary artery thermodilution, which is the gold standard for cardiac output measuring. The correlation coefficients r between the two methods ranged from 0.79 to 0.92. Bias and precision analysis ranged from -0.02 +/- 0.78 l/min/m2 to -0.14 +/- 0.73 l/min/m2. Additionally, data on practicality, limitations and clinical impact of the devices were collected. Conclusion: The accuracy of non-invasive cardiac output monitoring devices in trauma patients is broadly satisfactory. As the devices can be applied very early in the shock room or even preclinically, hemodynamic shock may be recognized much earlier and therapeutic interventions could be applied more rapidly and more adequately. The devices can be used in the daily routine of a busy ED, as they are non-invasive and easy to master. Keywords: Initial care, Hypovolemic shock, Non-invasive hemodynamic monitoring, Trauma
Introduction When managing trauma patients, it is crucial to evaluate the hemodynamic status to exclude hemorrhage. During the initial assessment, blood pressure and heart rate are commonly used to estimate blood loss. However, these parameters may be altered due to pain, hypothermia, neurogenic or cardiogenic shock or other factors related to the patient or to the injury. Moreover, analgesic, sedative or relaxing drugs may interfere with these conventional vital signs, thus making their interpretation difficult.
* Correspondence: [email protected] 1 Department of Visceral and Transplant Surgery, Bern University Hospital, Bern, Switzerland 3 Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland Full list of author information is available at the end of the article
Therefore, other diagnostic tools are required for hemorrhage detection. It has been shown that cardiac output is substantially different in hypotensive patients with or without blood loss. Low cardiac output then indicates blood los
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