Shock: Why do I not use Cardiovascular Monitoring?

Abstract

Hemodynamic monitoring has been the subject of many controversies in intensive care unit. Although several monitoring devices have provided interesting pathophysiological information during acute circulatory failure, it is today difficult to recommend their use in daily practice. Outside criticisms related to measurement accuracy or reproducibility, no study has clearly shown that these monitoring tools improved the prognosis of critically ill patients. The reasons for their clinical failure are many and include a lack of clear hemodynamic goals to achieve and a lack of consensus resulting from therapeutic intervention. More recently, discrepancies between global hemodynamic parameters such as heart rate or mean arterial pressure and microcirculatory perfusion increased doubt on their usefulness. Monitoring of microcirculatory tissue perfusion during shock states must in the future have a more important place in the management of acute circulatory failure.