Diseases of the cardiovascular system are one of the most common causes of death in Poland and in the world. Along with the progress of medicine and development of diagnostic methods, there are a growing number of useful procedures allowing for better monitoring of patient’s cardiovascular parameters and thereby more effective treatment. Monitoring of haemodynamic parameters of the circulatory system is necessary in patients hospitalised in anaesthesiology departments and in most intensive cardiac care units. The methods employed to evaluate the work of the heart can be divided into invasive and non-invasive, depending on whether they require a disruption of the continuity of the patient's tissues. In view of the ease of implementation of non-invasive methods, their costs and their implementability in practically every patient, these methods are used with increased frequency, both in patient care, as well as in measurements taken for scientific purposes. In recent years, several new methods have been developed which in many aspects are by no means inferior to the "golden standard" constituted by the invasive methods. When supported by medical knowledge and experience of health care professionals, they become particularly useful and valuable for improving medical care. This paper presents the latest of the currently available methods of haemodynamic monitoring. The mechanism of action of each of them has been explained, as well as the possibilities they present, the limitations they hold and the examples of their use in patient care.

haemodynamic monitoring; bioimpedance; electrocardiography

Marik PE. Noninvasive cardiac output monitors: a state-of the-art. review. Journal of Cardiothoracic and Vascular Anesthesia. 2013; 27: 121–34.

Raval NY, Squara P, Cleman M, Yalamanchili K, Winklmaier M, Burkhoff D. Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique. Journal of Clinical Monitoring and Computing. 2008; 22: 113–119.

Keren H, Burkhoff D, Squara P. Evaluation of a noninvasivecontinuous cardiac output monitoring system based on thoracic bioreactance. American Journal of Physiology. 2007; 293: H583-H589.

https://www.cheetah-medical.com/how-it-works/bioreactance/ (accessed: 2017.11.24)

Squara P, Denjean D, Estagnasie P, Brusset A, Dib JC, Dubois C. Noninvasive cardiac output monitoring (NICOM): a clinical validation. Intensive Care Medicine. 2007; 33: 1191–1194.

Kubicek WG, Karnegis JN, Patterson RP, Witsoe DA, Mattson RH. Development and evaluation of an impedance cardiac output system. Aerospace Medicine. 1966; 37(12): 1208-1212.

Siebert J. Kardiografia impedancyjna. Via Medica, Gdańsk 2006.

Sodolski T, Kutarski A. Impedance cardiography: A valuable method of evaluating haemodynamic parameters. Cardiology Journal. 2007; 14(2): 115-126.

Kim DW. Detection of physiological events by impedance. Yonsei Medical Journal. 1989; 30: 1-11.

Woltjer HH, Bogaard HJ, de Vries PM. The technique of impedance cardiography. European Heart Journal. 1997; 18: 1396-1403.

Summers RL, Shoemaker WC, Peacock WF, Ander DS, Coleman TG. Bench to bedside: electrophysiologic and clinical principles of noninvasive hemodynamic monitoring using impedance cardiography. Academic Emergency Medicine. 2003; 10: 669-680.

Strobeck J, Silver M. Beyond the four quadrants: the critical and emerging role of impedance cardiography in heart failure. Congestive Heart Failure. 2004; 10 (supl. 2): 1–6.

Krzesiński P, Gielerak G, Kowal J. Kardiografia impedancyjna – nowoczesne narzędzie terapii monitorowanej chorób układu krążenia. Kardiologia Polska. 2009; 67: 65–71.

Castor G, Molter G, Helms J, Niedermark I, Altmayer P. Determination of cardiac output during positive end-expiratory pressure--noninvasive electrical bioimpedance compared with standard thermodilution. Critical Care Medicine. 1990; 18(5): 544-546.

Spiess BD, Patel MA, Soltow LO, Wright IH. Comparison of bioimpedance versus thermodilution cardiac output during cardiac surgery: evaluation of a second-generation bioimpedance device. Journal of Cardiothoracic and Vascular Anesthesia. 2001; 15(5): 567-573.

Yung GL, Fletcher CC, Fedullo PF, Johnson FW, Kinninger K, Knowlton KU. Noninvasive cardiac index using bioimpedance in comparison to direct Fick and thermodilution methods in patients with pulmmonary hypertension. Chest. 1999; 116 (Suppl. 2): 281S.

Verhoeve PE, Cadwell CA, Tsadok S. Reproducibility of noninvasive bioimpedance measurements of cardiac function. Journal of Cardiac Failure. 1998; 4 (supl.): S3 (streszczenie).

Van De Water JM, Miller TW, Vogel RL, Mount BE, Dalton ML. Impedance cardiography: the next vital sign technology? Chest. 2003; 123: 2028-2033.

Yancy C, Abraham WT. Noninvasive hemodynamic monitoring in heart failure: utilization of impedance cardiography. Congestive Heart Failure. 2003; 9: 241-250.

Żuchowski B, Guzik P. Elektryczna bioimpedancja klatki piersiowej. Anesteziologia i Ratownictwo. 2008; 2: 434-442.

Zoremba N, Bickenbach J, Krauss B, Rossaint R, Kuhlen R, Schälte G. Comparison of electrical velocimetry and thermodilution techniques for the measurement of cardiac output. Acta Anaesthesiologica Scandinavica. 2007; 51: 1314-1319.

Chutkowski R, Malec-Milewska M. Kardiometria elektryczna – nowa metoda nieinwazyjnego monitorowania hemodynamicznego. Borgis - Postępy Nauk Medycznych. 2014; 5: 346-351.

Grollmuss O, Demontoux S, Capderou A, Serraf A, Belli E. Electrical velocimetry as a tool for measuring cardiac output in small infants after heart surgery. Intensive Care Medicine. 2012; 38(6): 1032-1039.

Schmidt C, Theilmeier G, Van Aken H, Korsmeier P, Wirtz SP, Berendes E et al. Comparison of electrical velocimetry and transoesophageal doppler echocardiography for measuring stroke volume and cardiac output. British Journal of Anaesthesia. 2005; 95(5): 603-610.

Osthaus WA, Hubert D, Beck C, Winterhalter M, Boethig D, Wessel A et al. Comparison of electrical velocimetry and transpulmonary thermodilution for measuring cardiac output in piglets. Pediatric Anesthesia. 2007; 17(8): 749-755.

Norozi K, Beck C, Osthaus WA, Wille I, Wessel A, Bertram H. Electrical velocimetry for measuring cardiac output in children with congenital heart disease. British Journal of Anaesthesia. 2008; 100(1): 88-94.

Raue W, Swierzy M, Koplin G, Schwenk W. Comparison of electrical velocimetry and transthoracic thermodilution technique for cardiac output assessment in critically ill patients. European Journal of Anaesthesiology. 2009; 26: 1067-1071.

O’Rourke MF, Seward JB. Centralne ciśnienie tętnicze i ciśnienie tętna sto lat po odkryciu Korotkowa. Medycyna po Dyplomie. 2007; 16: 99-110.

Kucewicz E, Czech B, Juszczyk G, Pawlak S, Szapiel G, Czaban S et al. Bezpośredni pomiar ciśnienia tętniczego krwi w tętnicy promieniowej – wiarygodność pomiaru w wybranych stanach klinicznych. Anestestezjologia i Intensywna Terapia. 2002; 2: 131-134.

Kaplan JA, Reich DL, Konstandt SN. Kaplan’s Cardiac Anesthesia, Elsevier Inc. 2006

http://www.medipment.pl/produkt/CNSYSTEMS-CNAP-Monitor-65305 (accessed: 2017.11.26)

https://www.draeger.com/Products/Content/infinity-cnap-smartpod-pi-9068562-pl.pdf (accessed: 2017.12.05)

Pawlak J, Zalewski P, Klawe JJ, Tafil-Klawe M. Nowoczesna metoda nieinwazyjnego ciągłego pomiaru ciśnienia krwi za pomocą urządzenia CNAP® Monitor 500 – praca przeglądowa. Acta Bio-Optica et Informatica Medica. 2012; 18: 202-205.

Dewhirst E, Corridore M, Klamar J, Beebe A, Rice J, Barry N et al. Accuracy of the CNAP monitor, a noninvasive continuous blood pressure device, in providing beat-to-beat blood pressure readings in the prone position. Journal of Clinical Anesthesia. 2013; 25(4): 309-313.

Ilies C, Kiskalt H, Siedenhans D, Meybohm P, Steinfath M, Bein B et al. Detection of hypotension during Caesarean section with continuous non-invasive arterial pressure device or intermittent oscillometric arterial pressure measurement. British Journal of Anaesthesia. 2012; 109(3): 413–419.

Piechota M. Monitorowanie czynności i dynamiki układu krążenia. MakMed. Lublin 2016