Continuous Non-Invasive Hemodynamic Monitoring in Cirrhotic Patients-Friend or Foe?

Background and

Objectives

Liver cirrhosis leads to significant hemodynamic changes, particularly portal hypertension and a hyperdynamic circulatory state. Traditional invasive methods for hemodynamic monitoring, while accurate, carry risks such as infection and hemorrhage in a patient predisposed to these conditions. This study evaluates the accuracy of non-invasive continuous hemodynamic monitoring compared to a minimally invasive method in patients with decompensated liver cirrhosis. Materials and Materials and

Methods

The study enrolled 51 patients with decompensated liver cirrhosis requiring continuous hemodynamic monitoring in the ICU. Patients underwent simultaneous monitoring via the minimally invasive FloTrac system and continuous non-invasive ClearSight sensor over 24 h, with measurements registered at 6 h intervals. Hemodynamic parameters measured included cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume variation (SVV), systemic vascular resistance (SVR), and mean arterial pressure (MAP).

Results

Significant discrepancies were observed between the two monitoring methods for most parameters, particularly CO, CI, and MAP, at most time intervals. However, SVV measurements showed no significant differences, indicating similar efficacy in assessing fluid responsiveness between the devices.

Conclusions

The ClearSight system, although a valuable non-invasive alternative, demonstrated lower accuracy compared to the FloTrac system for hemodynamic measurements in patients with decompensated liver cirrhosis. Its effectiveness in assessing fluid responsiveness, particularly by SVV, suggests it could play a role in the monitoring of these patients, especially when invasive techniques have increased risks.