# Continuous Non-Invasive Hemodynamic Monitoring in Cirrhotic Patients—Friend or Foe?

## TL;DR

This study compares non-invasive and minimally invasive methods for monitoring blood flow in cirrhotic patients, finding mixed accuracy and potential for non-invasive tools in specific cases.

## Contribution

The study evaluates non-invasive hemodynamic monitoring accuracy in decompensated cirrhosis patients, highlighting its limitations and potential for fluid responsiveness assessment.

## Key findings

- ClearSight showed significant discrepancies compared to FloTrac for CO, CI, and MAP measurements.
- SVV measurements were consistent between the two methods, indicating similar fluid responsiveness assessment.
- ClearSight is less accurate than FloTrac but may still be useful for specific monitoring needs in high-risk patients.

## Abstract

Background and Objectives: Liver cirrhosis leads to significant hemodynamic changes, particularly portal hypertension and a hyperdynamic circulatory state. Traditional invasive methods for hemodynamic monitoring, while accurate, carry risks such as infection and hemorrhage in a patient predisposed to these conditions. This study evaluates the accuracy of non-invasive continuous hemodynamic monitoring compared to a minimally invasive method in patients with decompensated liver cirrhosis. Materials and Materials and Methods: The study enrolled 51 patients with decompensated liver cirrhosis requiring continuous hemodynamic monitoring in the ICU. Patients underwent simultaneous monitoring via the minimally invasive FloTrac system and continuous non-invasive ClearSight sensor over 24 h, with measurements registered at 6 h intervals. Hemodynamic parameters measured included cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume variation (SVV), systemic vascular resistance (SVR), and mean arterial pressure (MAP). Results: Significant discrepancies were observed between the two monitoring methods for most parameters, particularly CO, CI, and MAP, at most time intervals. However, SVV measurements showed no significant differences, indicating similar efficacy in assessing fluid responsiveness between the devices. Conclusions: The ClearSight system, although a valuable non-invasive alternative, demonstrated lower accuracy compared to the FloTrac system for hemodynamic measurements in patients with decompensated liver cirrhosis. Its effectiveness in assessing fluid responsiveness, particularly by SVV, suggests it could play a role in the monitoring of these patients, especially when invasive techniques have increased risks.