Multimodal Non-Invasive Perfusion Monitoring at the Bedside
Abstract:
Background: The assessment of perfusion is a cornerstone in the management of critically ill patients. Over the last decade, hemodynamic monitoring has evolved toward less invasive modalities, supported by a growing understanding of vascular–tissue coupling and the availability of bedside technologies.
Methods: We present a case of acute coronary syndrome in which multimodal non-invasive hemodynamic monitoring was applied using a structured evaluation based on the interface model. Sequential assessments included capillary refill time (CRT), perfusion index, arterial line, near-infrared spectroscopy (NIRS), carotid VTI (VTIc), cardiac ultrasound (VTI LVOT), lactate and ΔCOâ‚‚,
Results: The integration of these complementary technologies provided a dynamic overview of the patient’s perfusion status and guided therapeutic decisions, including the titration of vasopressors and discontinuation of inotropes. CRT and perfusion index were the earliest parameters to normalize, while lactate kinetics lagged behind other perfusion markers. NIRS and VTIc revealed preserved cerebral autoregulation despite peripheral hypoperfusion, highlighting the dissociation between systemic and local signals. The interface-based approach facilitated recognition of hemodynamic coherence and individualized treatment at the bedside.
Conclusion: Multimodal non-invasive perfusion monitoring enables a tissue-centered interpretation of hemodynamic states beyond traditional macrovariables. By integrating minimally invasive technologies through the interface model, clinicians can better identify perfusion conflicts, refine diagnostic precision, and guide personalized therapy. This case illustrates how real-time, physiology-driven monitoring supports a shift toward individualized critical care rather than protocolized interventions.
