Static and Dynamic hemodynamic monitoring

Q: Central Venous Pressure (CVP) is considered as a _________ hemodynamic  monitoring? (Fill in the blank - select one)

A) Static 

B) Dynamic 

Answer: A

In acute care settings, there are two types of hemodynamic monitoring

- Static 

- Dynamic

In comparison, dynamic monitoring is more reliable. Static monitoring is assessible more readily on electronic medical record and trend provides a good sense of hemodynamics.

Static monitoring includes – blood pressure & Mean Arterial Pressure (MAP). Also, the following static measurements via central line can be used to determine adequate management:

• CVP
• ScvO2 (Central venous oxygen saturation)

Dynamic monitoring includes

• Respiratory variation in the vena caval diameter (via ultrasound)
• radial artery pulse pressure variation
• aortic blood flow peak velocity
• left ventricular outflow tract velocity-time integral
• carotid or brachial artery blood flow velocity 
• passive leg-raising maneuver

Said that, dynamic monitoring is highly dependent on cardiac rhythm and respiratory pattern. Tachypnea and arrhythmia can artifact reading and clinical judgement.

#hemodynamic

#cardiology

References:

1. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021; 49:e1063.

2. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345:1368.

3. ProCESS Investigators, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med 2014; 370:1683.

4. ARISE Investigators, ANZICS Clinical Trials Group, Peake SL, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014; 371:1496.