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C HAP TE R 21 / Hemodynamic Monitoring 499
CO and BP, and survivors had better preserved perfusion than 17. Hering, R., Wrigge, H., Vorwerk, R., et al. (2001). The effects of prone po-
nonsurvivors. 512,513 sitioning on intraabdominal pressure and cardiovascular and renal function
in patients with acute lung injury. Anesthesia & Analgesia, 92, 1226–1231.
These varying microcirculatory derangements occur even 18. Blanch, I., Mancebo, J., Perez, M., et al. (1997). Short-term effects of
though the global hemodynamic indicators are similar and alter- prone position in critically ill patients with acute respiratory distress syn-
ations in microcirculatory perfusion are often independent of drome. Intensive Care Medicine, 23, 1033–1039.
changes in MAP and CO. 96,504,513,515,517 These results suggest a 19. Jolliet, P., Bulpa, P., & Chevrolet, J. C. (1998). Effects of the prone po-
potential role for microcirculatory analysis as an early indicator of sition on gas exchange and hemodynamics in severe acute respiratory dis-
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tress syndrome. Critical Care Medicine, 26, 1977–1985.
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hypoperfusion, as a method to evaluate a patient’s response to ther- 20. Matejovic, M., Rokyta, R., Jr., Radermacher, P., et al. (2002). Effect of
apy and as a target for resuscitation. For example, studies evaluating prone position on hepato-splanchnic hemodynamics in acute lung in-
the effects of dobutamine and activated protein C in patients with jury. Intensive Care Medicine, 28, 1750–1755.
sepsis, both demonstrated increased capillary perfusion independ- 21. Borelli, M., Lampati, L., Vascotto, E., et al. (2000). Hemodynamic and gas
ent of systemic hemodynamics. 517,518 These studies also demon- exchange response to inhaled nitric oxide and prone positioning in acute res-
piratory distress syndrome patients. Critical Care Medicine, 28, 2707–2712.
strate the need to target both global (or macro) hemodynamics 22. Bridges, E., Evers, K. G., Schmelz, J., et al. (2005). Invasive pressure
(e.g., CO, ) and microhemodynamics (PslCO 2 or microcircu- monitoring at altitude. Critical Care Medicine, 33, A13.
lation with orthogonal polarization spectral imaging or sidestream 23. Bridges, E., & Middleton, R. (1997). Direct arterial vs oscillometric
dark-field imaging) and reiterate the limitations of solely using end- monitoring of blood pressure: Stop comparing and pick one (A decision-
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making algorithm). Critical Care Nurse, 17, 58–72.
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points such as MAP and CO to guide resuscitation. 24. Ramritu, P., Halton, K., Cook, D., et al. (2008). Catheter-related blood-
stream infections in intensive care units: A systematic review with meta-
analysis. Journal of Advanced Nursing, 62, 3–21.
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