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Hemodynamic Monitoring

Hemodynamic Monitoring in Bhubaneshwar

Children with health complications due to organ failure, sepsis, or cardiac complications are typically admitted to the paediatric intensive care unit for advanced treatment and monitoring. It's essential to diagnose and treat heart failure early to increase their chances of survival. Haemodynamic monitoring helps achieve this goal. This is an important part of ongoing cardiovascular function assessment, especially in critically ill children.

Haemodynamic monitoring is a method of monitoring blood flow and monitoring heart function. The real-time data provided by this test related to various key parameters such as blood pressure, heart rate, oxygen delivery to vital organs, and central venous pressure is crucial for treatment. This monitoring helps in determining the severity of paediatric circulatory derangement and identifies the root cause of the issue, aiding in planning the appropriate treatment. It also guides interventions to enhance cardiac function in children, such as medication adjustments, ventilatory support, and fluid resuscitation. In the PICU of Manipal Hospitals, Bhubaneswar, timely and accurate haemodynamic testing, tailored to meet the specific needs of each patient, improves treatment outcomes and reduces the risk of complications.

FAQ's

Haemodynamic monitoring is done in the following cases:

  • To find the reason for a patient fainting, which could be due to a sudden drop in blood pressure or heart rate, changes in blood volume, or a temporary decline in blood flow to the brain.

  • To guide treatment decisions in cases of cardiac failure or cardiac dysfunction in children.

  • Helps manage interventions like fluid therapy, medication adjustments, and ventilatory support.

Haemodynamic monitoring is done in critical care settings such as the PICU and in emergencies for the following conditions:

  • During major or high-risk surgeries
  • Trauma
  • Sepsis
  • Heart failure
  • Shock
  • Post-operative care

Haemodynamic monitoring can be of several types, such as:

Invasive monitoring: This involves a pulmonary artery catheter, transesophageal echocardiography, pulse contour cardiac output, and LidCO monitoring. 

Non-invasive monitoring: This includes Doppler ultrasound, blood pressure monitoring, impedance cardiography, and photoplethysmography. 

Minimally invasive monitoring: It includes arterial lines and venous pressure monitoring.

The healthcare provider will use the following:

  • Blood pressure monitoring will be done using a blood pressure cuff tied to your arm, which checks blood pressure during the test.

  • EKG monitoring is done by placing electrodes on your chest that send signals to an electrocardiograph monitor. The EKG recorded helps in knowing your heart rate and rhythm during the test.

  • Haemodynamic echo involves conducting an echocardiogram before the test, which gives a detailed picture of the heart. It also measures cardiac output, measured again during the test and compared with the initial reading. 

  • Nuclear medicine imaging uses a gamma camera that detects gamma rays and provides information regarding the workings of the heart and blood circulation.

Yes, as children are small in size and have developing systems, thus haemodynamic monitoring is performed using paediatric-sized equipment. Also, special care is provided to them during the testing to avoid complications. For them, non-invasive monitoring is generally preferred unless essential, such as in critically ill children.

The duration of haemodynamic monitoring depends on the patient’s condition. Usually, the test takes almost three hours to complete, but it may be extended over several days in critically ill patients to ensure ongoing stability and effective treatment. 

The invasive monitoring provides extensive information but carries some risk too. These include:

  • Infection at the catheter site

  • Bruising, redness, or swelling at the site of IV insertion

  • Bleeding or haematoma formation

  • Clot formation in the vessels

  • Vessel damage or arrhythmias 

  • Air embolism (although rare)

However, these risks can be minimised if performed by skilled professionals.

Yes, it is sometimes necessary to use invasive methods for monitoring when non-invasive methods do not guide treatment, especially in critically ill children. These include cases of severe stroke, heart failure, or when precise fluid management is important. It is also used when children are taking vasoactive drugs or mechanical ventilation.

The choice of monitoring method will depend on several factors, e.g., the severity of the child's illness, type of medical condition (e.g., stroke, sepsis, cardiac arrest), and the requirement of continuous monitoring or frequent blood tests. The availability of non-invasive alternatives and the risks versus benefits of the invasive procedures will also be considered.

Yes, newborns will need customised procedures because of their unique anatomy. For example, their blood pressure goals and responses to fluids and medications differ from those of older children. In neonates, noninvasive methods are generally preferred, although interventional care may be required in the most severe cases.

To measure central venous pressure, a catheter is usually inserted into a large vein in the neck or chest. Such testing helps to obtain information about the child’s volume status, right heart function, and venous return.

Arterial lines are used for continuous blood pressure monitoring, and arterial blood samples are obtained for gas analysis. This is especially useful for children with unstable heart conditions who require precise blood pressure monitoring and frequent blood tests.

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