Non-Invasive Hemodynamic Monitoring for Hemodynamic Management in Perioperative Medicine

In perioperative medicine, hemodynamic management aims at an optimization of perfusion pressure and oxygen delivery in order to maintain or restore adequate cellular metabolism (1). To optimize cardiopulmonary function, hemodynamic management triggers the administration of fluids and vasoactive agents according to predefined target values of hemodynamic variables. This is often referred to as “goal-directed therapy” (GDT). Although the general and vague term GDT comprises various (in part very different) hemodynamic treatment strategies (2), GDT has been shown to improve patient outcome, especially in high-risk patients undergoing major surgery (3–11). Besides basic hemodynamic variables (blood pressure and heart rate), GDT treatment algorithms usually include advanced hemodynamic variables such as pressureor volume-based cardiac preload variables (central venous pressure, pulmonary capillary wedge pressure, global end-diastolic volume), dynamic cardiac preload variables (pulse pressure variation, stroke volume variation), and blood flow variables (stroke volume, cardiac output). A variety of invasive, less-invasive, and non-invasive hemodynamic monitoring technologies are nowadays available to assess hemodynamic variables in the operating room or the intensive care unit. In this opinion paper, we will discuss how innovative non-invasive hemodynamic monitoring might be used for hemodynamic management in perioperative medicine.