Hemodynamic monitoring: To calibrate or not to calibrate? Part 2 - Non-calibrated techniques.

There is much evidence that fluid overload leads to adverse outcomes in perioperative and critically ill patients. Cardiac output monitoring can help us guiding initial and ongoing fluid resuscitation and can help us to assess whether a patient will be responsive to fluids when hypotensive. In recent years, many sophisticated devices that measure a variety of hemodynamic parameters have evolved on the market. We wanted to provide an overview of the different techniques available today, including their validation in different patient populations. In this second part of the review, we focus on non-calibrated techniques, both invasive and non-invasive. For each technique a short overview of the working principle, together with the advantages, disadvantages and the available validation literature is listed. Many promising minimal invasive monitoring devices can help us to further optimize our hemodynamic treatment in both the perioperative and critical care setting. However, the validation data are scarce for many of these techniques, especially in complex circumstances with changing hemodynamics (preload, afterload and contractility), as with the use of fluids and vasoactive medication. The measurements made by these devices, therefore, need to be interpreted with caution. Further improvements and more validation data are needed before these techniques can be implemented in common day practice. Moreover, in severely shocked hemodynamic unstable patients, calibrated techniques are to be preferred over those which are uncalibrated. Hence, the new techniques not only need to be accurate, but also need to be precise in order to keep track of changes.