Paradigm Shift in Hemodynamic Monitoring

Lailu Mathews

摘要

Since the beginning of modern anesthesia, in 1846, the anesthesiologist has relied on his natural senses like finger on the pulse to monitor the patient, aided recently by sophisticated instruments like stethoscope, sphygmomanometer, ECG etc. The first paradigm shift in hemodynamic monitoring can be traced back to the development of cardiac catheterization by Werner Forssmann in 1929 and subsequent introduction of pulmonary artery catheterization and thermodilution techniques, in 1970, by Swan, Ganz and colleagues. For more than three decades pulmonary artery catheter thermodilution method has generally been accepted and is still the clinical standard to which other methods are compared. The long history of use has led to much experience with its technology, clinical application and inadequacies. Recent advances in technology have led to the development of minimally invasive and non-invasive methods. The development of impedance cardiography and advances in electronics and signal processing has led to the development of completely non-invasive monitors which can provide continuous measurement of hemodynamic parameters and can be considered as the recent paradigm shift in critical care monitoring. The present article deals with the various invasive, minimally invasive and non-invasive techniques currently in use and their physiological basis. Introduction Thomas Kuhn who fathered, defined and popularized the concept of “paradigm shift” says in his popular book, The Structure of Scientific Revolution, that scientific advancement is not evolutionary, but rather is a “series of peaceful interludes punctuated by intellectually violent revolutions”, and in those revolutions “one conceptual world view is replaced by another”(Kuhn, Thomas, S., “The Structure of Scientific Revolutions”, Second Edition, Enlarged, The University of Chicago Press, Chicago, 1970(1962).The overthrow of Ptolemaic cosmology by Copernican heliocentrism, and the displacement of Newtonian mechanics by quantum physics and general relativity, is examples of major paradigm shifts. Both movements eventually changed the world view.Paradigm shift can be defined as movement from one thought system to another. It just does not happen, but rather is driven by agents of change. For example, agriculture changed early primitive human beings from wandering hunters to social beings. Likewise, the printing press, the making of books and the use of vernacular language changed the culture of a people and had a direct effect on scientific revolution. Johann Gutenberg's invention of movable type, in the 1440's, was an agent of change. Books became readily available, smaller and easier to handle and cheap to purchase. Masses of people acquired direct access to the scriptures, that heightened their awareness and attitudes began to change, as people were relieved from clutches of domination. Similarly, agents of change are driving a new paradigm shift today. The signs are all around us. For example, the introduction of the personal computer and the Internet have impacted both personal and business environments, and is shifting us from a mechanistic, manufacturing, industrial society to a service based, information centered society, and increases in technology will continue to impact globally. Change is inevitable. It's the only true constant.Hemodynamics is defined as the study behind the forces involved with blood circulation. Hemodynamic monitoring started with the estimation of heart rate using the simple skill of ‘finger on the pulse' and then moved on to more and more sophisticated techniques like stethescope, sphygmomanometer, ECG etc. The concept of measuring the pressure directly with in the veins, heart and arteries, originated in the minds of a German physician named Werner Forssmann in 1929, and can be considered as the first paradigm shift in hemodynamic monitoring. Working alone in 1929, Dr. Forssmann, threaded a urologic catheter through a vein in his arm and into his h

机译：自从1846年现代麻醉术开始以来，麻醉师就依靠他的自然感觉（例如用手指按脉搏）来监测患者，最近又借助诸如听诊器，血压计，ECG等先进的仪器进行辅助。血液动力学监测的第一个范例转变是最早可以追溯到Werner Forssmann在1929年开发出心脏导管术，随后在1970年由Swan，Ganz和同事们引入了肺动脉导管术和热稀释技术。三十多年来，肺动脉导管热稀释法已被普遍接受，并且仍然是与其他方法进行比较的临床标准。悠久的使用历史在其技术，临床应用和不足方面已经积累了很多经验。技术的最新进展导致了微创和非创方法的发展。阻抗心动图的发展以及电子和信号处理技术的进步，导致了完全无创监护仪的发展，该监护仪可以连续测量血流动力学参数，可以看作是重症监护监护领域的最新范例。本文介绍了当前使用的各种侵入性，微创和非侵入性技术及其生理基础。简介托马斯·库恩（Thomas Kuhn）曾在其著作《科学革命的结构》中提出，定义和普及了“范式转换”的概念，他说科学进步不是进化的，而是“一系列由知识暴力革命所打断的和平插曲”。，在那些革命中，“一种概念世界观被另一种世界观所取代”（库恩，托马斯，S。，《科学革命的结构》，第二版，放大版，芝加哥大学出版社，芝加哥，1970年，1962年）。哥白尼日心说推翻了托勒密宇宙论，量子物理学和广义相对论推翻了牛顿力学，这是主要范式转变的例子，两种运动最终改变了世界观。它只是没有发生，而是由变革的推动力驱动的，例如，农业将早期的原始人类从徘徊的猎人转变为社会众生。同样，印刷机，书籍的制作和白话的使用改变了人民的文化，对科学革命产生了直接的影响。约翰·古腾堡（Johann Gutenberg）在1440年代发明的可移动字体是变革的推动力。书籍变得容易获得，更小，更易于处理且购买便宜。随着人们摆脱了统治的束缚，群众直接接触了圣经，提高了他们的意识，态度开始改变。同样，变革的推动者今天正在推动新的范式转变。这些迹象都在我们周围。例如，个人计算机和Internet的引入已经影响了个人和商业环境，并使我们从机械，制造，工业社会转变为基于服务的，以信息为中心的社会，而技术的增长将继续对全球产生影响。变化是不可避免的。这是唯一的真实常数。血液动力学定义为与血液循环有关的力量背后的研究。血流动力学监测始于使用“指尖指尖”的简单技能来估算心率，然后转向越来越复杂的技术，如听诊器，血压计，ECG等。直接在静脉中测量压力的概念，心脏和动脉起源于1929年一位名叫Werner Forssmann的德国医生的脑海，被认为是血液动力学监测的第一个范例转变。 Forssmann博士于1929年独自工作，将一条泌尿科导管穿过他手臂的静脉并插入他的h

Paradigm Shift in Hemodynamic Monitoring

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