Use of shunt-side esCCO monitoring for hemodynamic management during hemodialysis as a novel approach for early detection of hypotension: a report of two cases.

Abstract

Early recognition of the signs of hypotension may lead to prompt intervention by medical professionals, reducing the risk of intradialytic hypotension. The study included two patients on dialysis, one with stable hemodynamics (Case 1) and one who developed hypotensive shock (Case 2), in whom noninvasive continuous hemodynamic monitoring using shunt-side estimated continuous cardiac output (esCCO) was performed. Noninvasive blood pressure (BP), heart rate, esCCO, estimated stroke volume, systemic vascular resistance, and decrease in blood volume of each patient before and after dialysis were evaluated in chronological order. In Case 1, esCCO decreased transiently with the decrease in blood volume, but with the adaptive change in heart rate and estimated stroke volume, the BP remained stable at the end. In Case 2, there was a rapid decrease in esCCO after the systemic vascular resistance compensation reached its limit, and esCCO decreased 30 min before a decrease in noninvasive BP became evident. These results indicate that shunt-side esCCO monitoring may detect signs of hypotension that cannot be detected using conventional BP monitoring systems. Monitoring using shunt-side esCCO may be a prospective method for intradialytic hemodynamic management.