Which haemodynamic monitoring should we chose for critically ill patients with acute circulatory failure?

Abstract

Purpose of reviewTo discuss the suitable haemodynamic monitoring for critically ill patients with shock.Recent findingsFor the basic initial monitoring, recent studies emphasized the importance of clinical signs of hypoperfusion and arterial pressure. This basic monitoring is not sufficient in patients resisting to initial treatment. Echocardiography does not allow multidaily measurements and has limitations, for measuring right or left ventricular preload. For a more continuous monitoring, noninvasive and minimally invasive tools are insufficiently reliable, as recently confirmed, and informative. The most invasive techniques, transpulmonary thermodilution and the pulmonary arterial catheter are more suitable. Their effect on outcome is lacking, although recent studies showed their benefit in acute heart failure. For assessing tissue oxygenation, recent publications better defined the meaning of the indices derived from the partial pressure of carbon dioxide. The integration of all data by artificial intelligence is the subject of early research in critical care.SummaryFor monitoring critically ill patients with shock, minimally or noninvasive systems are not reliable or informative enough. In the most severe patients, a reasonable monitoring policy can combine continuous monitoring by transpulmonary thermodilution systems or the pulmonary arterial catheter, with an intermittent assessment with ultrasound and measurement of tissue oxygenation.

The effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position: A quasi‐experimental study

“…Hemodynamic monitoring helps in decision-making in the clinical management of a patient by providing information on the patient's current physiological condition (Jeshvaghani et al, 2021). Achieving stability in hemodynamic parameters is the first and most important step in physiological recovery in surgical intensive care units (Monnet & Lai, 2023). Changing a patient's lying position to increase patient comfort and to ease pulmonary secretions is among the independent interventions carried out by nurses (Abd El-Moaty et al, 2017).…”