Open research questions in Hemodynamic Monitoring and Therapy

What the literature leaves open

• Future studies should focus on prospective multicenter interventional trials to determine whether validation and targeting DPP can reduce delirium incidence. Integration with cerebral individualized monitoring hemodynamic targets represents an important direction for future research. perfusion and

  Postoperative diastolic perfusion pressure as a predictor of delirium after cardiac surgery · 2026 · DOI

• Future work may focus on embedding the model into clinical informatics platforms to enable the real-time extraction of baseline characteristics, laboratory data, and treatment parameters, thereby facilitating automated risk stratification and early warning. Clinically, heightened vigilance is warranted in such patients, and prompt identification and management of the underlying primary disease should be prioritized. Future multicenter, large-scale cohort studies are warranted to further validate and enhance the robustness and applicability of the model.

  Machine learning model for predicting hypotension following continuous renal replacement therapy initiation in end-stage kidney disease patients: a SHAP-interpretable approach · 2026 · DOI

• Second, this study focused on female mice, reflecting evidence that high-level SCI produces more pronounced renal dysfunction in females23; whether similar dynamics occur in males remains to be determined.

  Frequency-Domain Analysis Links Autonomic Disruption to Renal Autoregulatory Failure after Spinal Cord Injury · 2026 · DOI

• emphasizing mechanism-directed escalation, cardiac output or stroke volume monitoring in high-risk patients, and structured responses to hemo- dynamic instability [15, 16]. Importantly, organ perfusion pressure is determined by the arteriovenous pressure gradient, not by MAP alone. Renal perfusion pressure, for example, can be approximated as MAP minus central venous pressure. Positive-pressure ventilation, high posi- tive end-expiratory pressure, fluid overload, increased intra-abdominal pressure, and right ventricular dysfunc- tion may therefore reduce effective renal or splanchnic perfusion despite apparently adequate MAP. Venous congestion should consequently be treated as an active hemodynamic threat rather than a secondary observa- tion. This is particularly relevant during major abdominal surgery, pneumoperitoneum, Trendelenburg position- ing, high airway pressures, right ventricular dysfunction, and postoperative fluid accumulation. In these settings, increasing MAP with vasopressors may improve the arterial side of the gradient, but reducing venous back- pressure or intra-abdominal pressure may be equally important for restoring effective perfusion. Special populations make the limitations of univer- sal thresholds more visible. Patients with neurological disease may have impaired or pressure-dependent cer- ebral autoregulation, and perioperative targets cannot be extrapolated mechanically from general abdominal surgi- cal populations [17].

  Perioperative arterial pressure management: from fixed thresholds to physiology-guided perfusion support · 2026 · DOI

• These comprehensive data establish a monitoring‑based physiological baseline for hypothesis‑generating research in high‑risk obstetric populations and support further investigation of TTE as an early warning monitor in perioperative care.

  Serial transthoracic echocardiography for hemodynamic monitoring and early warning of hypotension during elective cesarean delivery: a prospective observational study · 2026 · DOI

• Whether similar hemodynamic trajectories occur in such patients remains to be investigated. LVEF remained stable, consistent with preload reduction playing an important role, although the relative contribution of afterload reduction could not be determined.

  Serial transthoracic echocardiography for hemodynamic monitoring and early warning of hypotension during elective cesarean delivery: a prospective observational study · 2026 · DOI

• Given the influence of the prevalence on the NPV, these findings need to be validated in other settings.

  Hyperspectral imaging for objective microcirculatory assessment in trauma patients · 2026 · DOI

• 3) (23), and its strategy in patients undergoing neuraxial anesthesia surgery remains to be validated.

  Noninvasive predictive value of preoperative perfusion index for intraoperative hemodynamic fluctuations in patients undergoing lower-extremity orthopedic surgery under regional anesthesia: a retrospective cohort study · 2026 · DOI

• A pre-specified subgroup analysis suggested a potential benefit with minimally invasive/non- invasive devices, but this finding is based on limited data and requires prospective validation.

  Dynamic parameter-guided goal-directed fluid therapy and postoperative acute kidney injury in non-cardiac surgery: a meta-analysis of 11 randomized controlled trials · 2026 · DOI

• This pat- tern may reflect progressive deterioration in hemodynamic responsiveness, although the underlying mechanisms could not be determined from the available data.

  48-hour BPRI trajectories and 28-day mortality in vasoactive-supported hypertensive heart disease with heart failure · 2026 · DOI

• Estimated cost savings are based on published reductions in resource utilization and representative hospital cost estimates adjusted for inflation and may not be generalizable across institutions with differing reimbursement models, implementation costs, or practice patterns.

  Critical Care Ultrasound-Guided Targeted Volume Management as Precision Medicine: Predicting Clinical and Financial Impacts · 2026 · DOI

• In contrast, documented experience with this technology in pediatric settings remains sparse.

  FloTrac-guided real-time hemodynamic management for pheochromocytoma resection in a pediatric patient: a case report · 2026 · DOI

• Larger multi- center trials with invasive monitoring and extended postoperative follow-up are warranted.

  A Comparative Study of Clonidine and Bromazepam on Haemodynamic Stability During Spine Fusion Surgery in Hypertensive Patients · 2026 · DOI

• INTRODUCTION: Trends in upright seated pulmonary artery pressure (PAP) with synchronous measurement of weight, blood pressure (BP), and heart rate (HR) have not been compared prior to heart failure events (HFE) and other causes of hospitalization during remote monitoring.

  Changes in upright haemodynamics preceding heart failure events and other hospitalizations · 2026 · DOI

• The IJV could be explored by US in almost all patients, unlike the IVC (22% failure).

  Jugular venous ultrasound for the assessment of congestion in the emergency department · 2026 · DOI

• Several non-invasive approaches to assess SV, bio-impedance (NICaS®, total body bioimpedance, PhysioFlow®, thoracic bioimpedance) and echocardiography (2D and 3D-DHM 60/30), have been developed, but their accuracy, especially in atrial fibrillation (AF), remains uncertain.

  Assessment of stroke volume and cardiac output in real-world HF patients: a comparison of bioimpedance methods, 2D/3D echocardiography, and thermodilution in patients with sinus rhythm and AF · 2026 · DOI

• Intraprocedural hypotension may compromise cerebral perfusion and worsen neurological outcomes, yet existing evidence is inconsistent, and no prior meta-analysis has synthesized observational data on intraoperative hypotension during EVT.

  Intraoperative Hypotension During Endovascular Therapy for Acute Ischemic Stroke and Functional Outcomes: A Systematic Review and Meta-Analysis · 2026 · DOI

• BACKGROUND: Optimal blood pressure management during endovascular therapy (EVT) for acute ischemic stroke remains uncertain.

  Intraoperative Hypotension During Endovascular Therapy for Acute Ischemic Stroke and Functional Outcomes: A Systematic Review and Meta-Analysis · 2026 · DOI

• Summary Introduction Intra‐operative hypotension is common during general anaesthesia, but its association with postoperative pneumonia remains uncertain, partly because hypotension has been defined using different thresholds.

  Intra‐operative hypotension threshold models and subdistribution hazard of postoperative pneumonia in patients having non‐cardiac surgery · 2026 · DOI

• Studies investigating the cardiovascular effects of persistent subclinical hypervolemia—characterized by euvolemia at clinical assessment but hypervolemia at technical evaluation—are lacking.

  Potential implications of subclinical hypervolemia, identified by a multiparametric approach, in causing left ventricular hypertrophy in clinically euvolemic children on dialysis: a prospective longitudinal pilot study · 2026 · DOI

• However, its prognostic role in earlier stages of heart failure (HF) or pre HF remains unclear.

  3D echocardiography derived cardiac power output as an independent prognostic marker for heart failure in young patients with STEMI · 2026 · DOI

• CONCLUSIONS: The results indicate the effectiveness of PINNs in achieving super-resolution from sparse data, as well as a quantitative measure of hemodynamics within a microvascular network.

  1378 Determination of Blood Perfusion and Hemodynamics Using Physics-Informed Neural Networks for Use in Stroke Severity Assessment · 2025 · DOI

• Future studies are warranted to validate these findings and to assess the role of LSM for the screening, diagnosis, monitoring, and prognostic stratification of patients with HF.

  Liver Stiffness Measurement for Non-Invasive Assessment of Central Venous Pressure in Patients with Heart Failure: A Multicentre Pilot Study · 2025 · DOI

• Whether this procedure can improve patient outcomes is unknown, and future studies are needed to address this question.

  An echocardiography-based strategy for volume management: Assessment from volume status and responsiveness to tolerance · 2025 · DOI

• Analysis on sPAP values had mixed results as to the detection of pulmonary hypertension (PH).

  A prospective study on the correlation of right atrial pressure determined non-invasively via inferior vena cava versus tricuspid E/e among patients undergoing dobutamine stress echocardiography · 2025 · DOI

Most-cited papers in Hemodynamic Monitoring and Therapy

• Coronary Perfusion Pressure and the Return of Spontaneous Circulation in Human Cardiopulmonary Resuscitation · JAMA · 1990 · 900 citations
• Logistic Regression in Medical Research · Anesthesia & Analgesia · 2021 · 381 citations
• Pulse Transit Time as an Indicator of Arterial Blood Pressure · Psychophysiology · 1981 · 260 citations
• Emergency Department Bedside Ultrasonographic Measurement of the Caval Index for Noninvasive Determination of Low Central Venous Pressure · Annals of Emergency Medicine · 2009 · 238 citations
• Prediction of fluid responsiveness. What’s new? · Annals of Intensive Care · 2022 · 203 citations
• Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery · Annals of Internal Medicine · 2023 · 167 citations
• Using a weighted average of base period price indexes to approximate a superlative index · Journal of Official Statistics · 2009 · 128 citations
• Moderate controlled hypotension with sodium nitroprusside does not improve surgical conditions or decrease blood loss in endoscopic sinus surgery · Journal of Clinical Anesthesia · 2000 · 91 citations
• Vagal slowing of the heart during haemorrhage: observations from 20 consecutive hypotensive patients. · BMJ · 1986 · 85 citations
• Cardiac index measurements during rapid preload changes: a comparison of pulmonary artery thermodilution with arterial pulse contour analysis · Journal of Clinical Anesthesia · 2005 · 71 citations

Most recent work

• Fluid responsiveness and changes in venous congestion and lung water during volume expansion in critically ill patients: a multicentre observational study · Critical Care · 2026
• Ultrafiltration in the critically ill patient: a framework for personalized care · Critical Care · 2026
• Passive leg raising and microvascular skin blood flow to predict peripheral tissue perfusion fluid responsiveness · Critical Care · 2026
• Proactive haemodynamic management using the hypotension prediction index during caesarean section: a randomised controlled study · Anaesthesia · 2026
• A comprehensive review of venous excess ultrasound (VExUS) score: evidence from original research · Internal and Emergency Medicine · 2026
• Intraoperative hypotension trajectories and their predictive value for major postoperative complications: a retrospective cohort study · Frontiers in Medicine · 2026
• Assessment of Congestion in Heart Failure Using VExUS: Current Evidence, Limitations and Clinical Perspectives · Life · 2026
• Change in vasoactive inotropic score following hydrocortisone administration in the pediatric intensive care unit: a PICU data collaborative study, 2010–2022 · Frontiers in Pediatrics · 2026
• Experimental evaluation of a real-time implementation of compensatory reserve measurement in a human model of hemorrhagic shock · Frontiers in Bioengineering and Biotechnology · 2026
• Association of Perioperative Steps and Heart Rate Variability from Wearable Devices with Surgical Outcomes · Journal of the American College of Surgeons · 2026

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