Key result
PRAM enables uncalibrated beat-to-beat stroke volume monitoring as a viable hemodynamic alternative.
Why the study?
Established methods for cardiac output monitoring are invasive, non-continuous, unreliable in hemodynamically unstable patients, and have technical drawbacks, prompting evaluation of alternative methods.
New CO monitoring methods may enable continuous assessment in unstable patients; level 5 evidence leaves open validation and clinical adoption.
Monitoring of Cardiac Output (CO) is of paramount importance in the critical patient. Established methods used to measure CO, such as oxygen Fick approach and thermodilution, are invasive and do not allow continuous monitoring. In addition, they are not reliable in the hemodynamically instable patient and suffer several technical drawbacks. Alternative methods are available, such as the Pulse Contour Method, but are dependent upon external calibration to evaluate cardiac activity. Recently, the Pressure Recording Analytical Method (PRAM) has been developed: it allows a more complete and detailed analysis of pressure morphology and "beat-to-beat" measurement of the stroke volume (SV) without external calibration. The basic principle of PRAM algorithm is the ability of detecting interactions between the cardiac and circulatory system, and therefore of calculating a new parameter, describing the work expenditure of cardiovascular system strictly correlated to SV, the Cardiac Cycle Efficiency (CCE). PRAM is becoming a promising alternative to traditional techniques, and may expand the potential applications of hemodynamic monitoring in clinical practice.
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Romano et al. (2006) conducted a review in Hemodynamic instability. Pressure Recording Analytical Method (PRAM) vs. Traditional techniques (oxygen Fick approach, thermodilution, Pulse Contour Method) was evaluated. The Pressure Recording Analytical Method (PRAM) allows beat-to-beat measurement of stroke volume without external calibration, serving as a promising alternative to traditional hemodynamic monitoring.
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