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Insuficiencia cardíaca

On-line version ISSN 1852-3862


LOBO MARQUEZ, Lilia Luz. Hemodynamic monitoring: PIU AVANTI!. Insuf. card. [online]. 2007, vol.2, n.4, pp.149-152. ISSN 1852-3862.

Recognizing the actual hemodynamic status of chronic cardiac failure (CCF) in an unstable patient is a clinical challenge which encourages invasive monitoring with Swan-Ganz catheter. The ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) study compared two therapeutic approaches based on clinical variables and hemodynamic monitoring (HM). The end-points for death or hospital-stay showed no significant differences at six months' followup. The lack of a protocol for intravenous therapy adjusted to hemodynamic variables has led practitioners to support intervention on medical judgment; hence, the findings observed in the group treated with invasive measures might have been biased by the range of the clinical approaches used. A group of ESCAPE patients with a clear indication of HM (i.e. refractory, unstable patients) are candidates for adjusted therapy in an attempt to achieve hemodynamic values associated with improved survival in the study. However, such a group was not studied. Adjustments should be obviously made so as to make sure patients receive medication known to cause no negative impact on either short or long-term outcome. Understanding hemodynamic variables and continuous ambulatory monitoring of chronic cardiac failure patients may yield a different impact from that noted in the ESCAPE study. The use of new devices should allow for the implementation of the out-patient oral approach in an effort to prevent hemodynamic congestion. Thus, it is not the knowledge and the management of hemodynamic variables that may prove to be useless, but the lack of knowledge to cope with valuable data.

Keywords : Cardiac failure; Clinical variables; Hemodynamic monitoring.

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