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Is There a Role for Invasive Hemodynamic Monitoring in Acute Heart Failure Management?

  • Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)
  • Published:
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Abstract

The place of invasive hemodynamic monitoring in patients with acute heart failure is still debated, even though frequently used. Invasive techniques, which include the pulmonary artery catheter and transpulmonary thermodilution, provide important information on cardiac output and intravascular pressures or volume. These techniques should be used in combination with echocardiography and allow nurse-driven semicontinuous hemodynamic monitoring. These techniques are useful not only in the diagnosis of circulatory or respiratory failure but also for the evaluation of the effects of therapies. Admittedly, large-scale randomized trials failed to demonstrate a survival benefit with the pulmonary artery catheter (and were even not yet performed with transpulmonary thermodilution). However, these trials may be subjected to selection bias, as patients from recruiting centers not included in the trial but receiving the pulmonary artery catheter were more severe and had higher mortality rates than patient included in the trial. Hence, invasive techniques may still have a place in selected patients with acute circulatory failure and especially in the most severe cases.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. De Backer D, Fagnoul D, Herpain A. The role of invasive techniques in cardiopulmonary evaluation. Curr Opin Crit Care. 2013;19(3):228–33.

    Article  PubMed  Google Scholar 

  2. Hemodynamic monitoring using echocardiography in the critically ill. Heidelberg Dordrecht London New York: Springer; 2011. Comprehensive book reporting how to use echocardiography for hemodynamic assessment.

  3. International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med 2014 May;40(5):654-66.Consensus of several international scientific societies describing the requirements and pathways for training in advanced echocardiography.

  4. Koo KK, Sun JC, Zhou Q, Guyatt G, Cook DJ, Walter SD, et al. Pulmonary artery catheters: evolving rates and reasons for use. Crit Care Med. 2011;39(7):1613–8. Important paper showing changes over time in the incidence and indications of use of pulmonary artery catheter.

    Article  PubMed  Google Scholar 

  5. Jeger RV, Lowe AM, Buller CE, Pfisterer ME, Dzavik V, Webb JG, et al. Hemodynamic parameters are prognostically important in cardiogenic shock but similar following early revascularization or initial medical stabilization: a report from the SHOCK Trial. Chest. 2007;132(6):1794–803.

    Article  PubMed  Google Scholar 

  6. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369(18):1726–34. Comprehensive review on management of circulatory shock.

    Article  CAS  PubMed  Google Scholar 

  7. Reuter DA, Kirchner A, Felbinger TW, Weis FC, Kilger E, Lamm P, et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit Care Med. 2003;31(5):1399–404.

    Article  PubMed  Google Scholar 

  8. Mahjoub Y, Pila C, Friggeri A, Zogheib E, Lobjoie E, Tinturier F, et al. Assessing fluid responsiveness in critically ill patients: false-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle. Crit Care Med. 2009;37(9):2570–5.

    Article  PubMed  Google Scholar 

  9. De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med. 2005;31(4):517–23.

    Article  PubMed  Google Scholar 

  10. Heenen S, De Backer D, Vincent JL. How can the response to volume expansion in patients with spontaneous respiratory movements be predicted? Crit Care. 2006;10(4):R102.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Mimoz O, Rauss A, Rekik N, Brun-Buisson C, Lemaire F, Brochard L. Pulmonary artery catheterization in critically ill patients: a prospective analysis of outcome changes associated with catheter-prompted changes in therapy. Crit Care Med. 1994;22(4):573–9.

    Article  CAS  PubMed  Google Scholar 

  12. Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, de Boisblanc B, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213–24.

    Article  PubMed  Google Scholar 

  13. Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2003;290(20):2713–20.

    Article  CAS  PubMed  Google Scholar 

  14. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348:5–14.

    Article  PubMed  Google Scholar 

  15. Binanay C, Califf RM, Hasselblad V, O’Connor CM, Shah MR, Sopko G, et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. 2005;294(13):1625–33.

    Article  PubMed  Google Scholar 

  16. Gnaegi A, Feihl F, Perret C. Intensive care physicians’ insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med. 1997;25:213–20.

    Article  CAS  PubMed  Google Scholar 

  17. Iberti TJ, Fischer EP, Leibowitz AB, Panacek EA, Silverstein JH, Albertson TE. A multicenter study of physicians’ knowledge of the pulmonary artery catheter. Pulmonary Artery Catheter Study Group. JAMA. 1990;264:2928–32.

    Article  CAS  PubMed  Google Scholar 

  18. Jain M, Canham M, Upadhyay D, Corbridge T. Variability in interventions with pulmonary artery catheter data. Intensive Care Med. 2003;29(11):2059–62.

    Article  PubMed  Google Scholar 

  19. De Backer D. Hemodynamic assessment: the technique or the physician at fault? Intensive Care Med. 2003;29:1865–7.

    Article  PubMed  Google Scholar 

  20. De Backer D, Schortgen F. Physicians declining patient enrollment in clinical trials: what are the implications? Intensive Care Med. 2014;40(1):117–9. Editorial discussing the implications of refusal of inclusion in clinicl trials by attending physicians in centres taking part in randomized trials. This behavior frequently induces selection bias, leading to inclusion of less severe patients in the trial than in "real life".

    Article  PubMed  Google Scholar 

  21. Allen LA, Rogers JG, Warnica JW, Disalvo TG, Tasissa G, Binanay C, et al. High mortality without ESCAPE: the registry of heart failure patients receiving pulmonary artery catheters without randomization. J Card Fail. 2008;14(8):661–9.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Cope DK, Grimbert F, Downey JM, Taylor AE. Pulmonary capillary pressure: a review. Crit Care Med. 1992;20(7):1043–56.

    Article  CAS  PubMed  Google Scholar 

  23. Carter RS, Snyder JV, Pinsky MR. LV filling pressure during PEEP measured by nadir wedge pressure after airway disconnection. Am J Physiol. 1985;249(4 Pt 2):H770–6.

    CAS  PubMed  Google Scholar 

  24. Pinsky M, Vincent JL, De Smet JM. Estimating left ventricular filling pressure during positive end-expiratory pressure in humans. Am Rev Respir Dis. 1991;143(1):25–31.

    Article  CAS  PubMed  Google Scholar 

  25. Teboul JL, Pinsky MR, Mercat A, Anguel N, Bernardin G, Achard JM, et al. Estimating cardiac filling pressure in mechanically ventilated patients with hyperinflation. Crit Care Med. 2000;28:3631–6.

    Article  CAS  PubMed  Google Scholar 

  26. Ventetuolo CE, Klinger JR. Management of acute right ventricular failure in the intensive care unit. Ann Am Thorac Soc. 2014;11(5):811–22.

    Article  PubMed  Google Scholar 

  27. Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S. Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice. Chest. 2011;139(5):988–93. Comparision of measuremnts of pulmonaryartery pressure by echocardiography and with pulmonary artery catheter. This study questions the reliability of echocardiographic measurements.

    Article  PubMed  Google Scholar 

  28. Arcasoy SM, Christie JD, Ferrari VA, Sutton MS, Zisman DA, Blumenthal NP, et al. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med. 2003;167(5):735–40.

    Article  PubMed  Google Scholar 

  29. De Backer D, Marx G, Tan A, Junker C, Van NM, Huter L, et al. Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients. Intensive Care Med. 2011;37(2):233–40.

    Article  PubMed Central  PubMed  Google Scholar 

  30. van Lieshout JJ, Wesseling KH. Continuous cardiac output by pulse contour analysis? Br J Anaesth. 2001;86(4):467–9.

    Article  PubMed  Google Scholar 

  31. Michard F. Pulse contour analysis: fairy tale or new reality? Crit Care Med. 2007;35(7):1791–2.

    Article  PubMed  Google Scholar 

  32. Hamzaoui O, Monnet X, Richard C, Osman D, Chemla D, Teboul JL. Effects of changes in vascular tone on the agreement between pulse contour and transpulmonary thermodilution cardiac output measurements within an up to 6-hour calibration-free period. Crit Care Med. 2008;36(2):434–40.

    Article  PubMed  Google Scholar 

  33. Langewouters GJ, Wesseling KH, Goedhard WJ. The pressure dependent dynamic elasticity of 35 thoracic and 16 abdominal human aortas in vitro described by a five component model. J Biomech. 1985;18(8):613–20.

    Article  CAS  PubMed  Google Scholar 

  34. Langewouters GJ, Wesseling KH, Goedhard WJ. The static elastic properties of 45 human thoracic and 20 abdominal aortas in vitro and the parameters of a new model. J Biomech. 1984;17(6):425–35.

    Article  CAS  PubMed  Google Scholar 

  35. Ritter S, Rudiger A, Maggiorini M. Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study. Crit Care. 2009;13(4):R133.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Perny J, Kimmoun A, Perez P, Levy B. Evaluation of cardiac function index as measured by transpulmonary thermodilution as an indicator of left ventricular ejection fraction in cardiogenic shock. Biomed Res Int. 2014;2014:598029. Intersting paper evaluating the relationship between transpulmonary and echocardiographic indicators of left heart function. Transpulmonary indices perform well in predominant left heart failure but underestimate left heart function in patients with right ventricular dysfunction.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Belda FJ, Aguilar G, Teboul JL, Pestana D, Redondo FJ, Malbrain M, et al. Complications related to less-invasive haemodynamic monitoring. Br J Anaesth. 2011;106(4):482–6. Large multicentric cohort evaluating complications of transpulmonary thermodilution. Site hematoma and catheter infections were the sole complications reported by incvestigators, with similar incidence as with central venous and arterial catheterization with usual catheters.

    Article  CAS  PubMed  Google Scholar 

  38. Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med. 1984;12(7):549–53.

    Article  CAS  PubMed  Google Scholar 

  39. Grissom CK, Morris AH, Lanken PN, Ancukiewicz M, Orme Jr JF, Schoenfeld DA, et al. Association of physical examination with pulmonary artery catheter parameters in acute lung injury. Crit Care Med. 2009;37(10):2720–6.

    Article  PubMed  Google Scholar 

  40. De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002;166:98–104.

    Article  PubMed  Google Scholar 

  41. De Backer D, Creteur J, Dubois MJ, Sakr Y, Vincent JL. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J. 2004;147:91–9.

    Article  PubMed  Google Scholar 

  42. den Uil CA, Lagrand WK, van der Ent M, Jewbali LS, Cheng JM, Spronk PE, et al. Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2010;31:3032–9.

    Article  Google Scholar 

  43. Teboul JL, Annane D, Thuillez C, Depret J, Bellissant E, Richard C. Effects of cardiovascular drugs on oxygen consumption/oxygen delivery relationship in patients with congestive heart failure. Chest. 1992;101:1582–7.

    Article  CAS  PubMed  Google Scholar 

  44. Goepfert MS, Reuter DA, Akyol D, Lamm P, Kilger E, Goetz AE. Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients. Intensive Care Med. 2007;33(1):96–103.

    Article  PubMed  Google Scholar 

  45. Mutoh T, Kazumata K, Terasaka S, Taki Y, Suzuki A, Ishikawa T. Impact of transpulmonary thermodilution-based cardiac contractility and extravascular lung water measurements on clinical outcome of patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage: a retrospective observational study. Crit Care. 2014;18(4):482. Patients with Takotsubo after subarachnoid hemorrhage who have a low cardiac function index and high extravascular lung water present a poor neurologic outcome.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Mutoh T, Kazumata K, Terasaka S, Taki Y, Suzuki A, Ishikawa T. Early intensive versus minimally invasive approach to postoperative hemodynamic management after subarachnoid hemorrhage. Stroke. 2014;45(5):1280–4. Randomized trial of goal directed therapy in patients with subarachnoid hhemorrhage. Goal directed therapy is associated with a better neurologic outcome compared to usual care.

    Article  PubMed  Google Scholar 

  47. Wilson J, Woods I, Fawcett J, Whall R, Dibb W, Morris C, et al. Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ. 1999;318:1099–103.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Adler C, Reuter H, Seck C, Hellmich M, Zobel C. Fluid therapy and acute kidney injury in cardiogenic shock after cardiac arrest. Resuscitation. 2013;84(2):194–9. Small size randomized trial showing improvement in renal function in patients monitored with transpulmonary thermodilution.

    Article  PubMed  Google Scholar 

  49. Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J. A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg. 2000;90(5):1052–9.

    Article  CAS  PubMed  Google Scholar 

  50. Trof RJ, Beishuizen A, Cornet AD, de Wit RJ, Girbes AR, Groeneveld AB. Volume-limited versus pressure-limited hemodynamic management in septic and nonseptic shock. Crit Care Med. 2012;40(4):1177–85. Randomized trial comparing pulmonary artery catheter to transpulmonary thermodilution in cricially ill patients. No differneces in outcome were observed in patient with septic shock. In patints with impaired cardiac function, pulmonary artery catheter was associated with lowertime under mechanicl ventilation while survival was not affected.

    Article  PubMed  Google Scholar 

  51. Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, et al. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anaesthesiology. 1988;69:171–9.

    Article  CAS  Google Scholar 

  52. Vignon P, AitHssain A, Francois B, Preux PM, Pichon N, Clavel M, et al. Echocardiographic assessment of pulmonary artery occlusion pressure in ventilated patients: a transoesophageal study. Crit Care. 2008;12(1):R18.

    Article  PubMed Central  PubMed  Google Scholar 

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Conflict of Interest

Daniel De Backer has received nonfinancial support from Edwards Lifesciences, PULSION, Vytech, and ImaCor.

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This article does not contain any studies with human or animal subjects performed by any of the authors

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  1. Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Rue Wayez 35, B-1420 Braine L’Alleud, Brussels, Belgium

    Daniel De Backer

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Correspondence to Daniel De Backer.

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This article is part of the Topical Collection on Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise

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De Backer, D. Is There a Role for Invasive Hemodynamic Monitoring in Acute Heart Failure Management?. Curr Heart Fail Rep 12, 197–204 (2015). https://doi.org/10.1007/s11897-015-0256-6

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