Cardiogenic shock monitoring

Abstract

Patients with cardiogenic shock exhibit two different clinical scenarios: the classical, which associates severe hypokinetic shock and elevated pulmonary pressures, and the new scenario in which severe myocardial depression is associated with low systemic resistances. Individualized pulmonary artery catheter use is recommended for severely hypotensive cardiogenic shock patients. Clinical assessment with echocardiography is a reasonable alternative in the less severe patients. Transpulmonary thermodilution associated with continuous measurement of mixed venous oxygen saturation (SvO₂) is a reasonable alternative in others. Measurements of SvO₂, arterial lactate concentration, and venous-arterial pCO₂ difference are reliable to assess tissue oxygenation andmacrocirculation. Brain natriuretic peptide (BNP) could be useful to monitor the effects of medications on ventricular dysfunction.