Shock: Why I use Cardiovascular Monitoring?

Abstract

In the debate between utility and futility, safety and invasiveness, reliability and unreliability of cardiovascular monitoring techniques, several arguments advocate for their use in the most severe patients. First, some physiological evidence and several clinical studies indicate that a number of cardinal hemodynamic variables (heart rate, cardiac preload, systolic heart function or lung water) are not properly estimated by clinical, biological or radiological assessment, while they are by monitoring tools. Then, the rate of compli-cations associated with these techniques is low, if compared to the severity of patients in whom they are used. Moreover, the unreliability of some techniques cannot reasonably be used to discredit the reliability of well-established techniques. Also, the argument that cardiovascular monitoring is futile because no study has shown that it improves the prognosis of patients in shock must be overridden. Indeed, the monitoring tools have mostly been evaluated without any decision protocol is attached to it. Many other monitoring tools are used in shock patients without being required to prove improving prognosis. Finally, the argument that the measurement and interpretation of some variables is complex cannot justify that they should not be used. The management of such patients requires many other expert skills.