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Monitoring: from cardiac output monitoring to echocardiography

Jozwiak, Mathieua,b; Monnet, Xaviera,b; Teboul, Jean-Louisa,b

Current Opinion in Critical Care: October 2015 - Volume 21 - Issue 5 - p 395–401
doi: 10.1097/MCC.0000000000000236
CARDIOVASCULAR SYSTEM: Edited by Maurizio Cecconi

Purpose of review Hemodynamic exploration is mandatory in patients with shock to identify the type of shock, to select the best therapeutic strategy, and to assess the efficacy of the selected therapy. In this review, we summarize the characteristics of the main available hemodynamic monitoring systems and emphasize on how to select the most appropriate ones in patients with circulatory shock.

Recent findings Over the past decade, hemodynamic monitoring techniques have progressively evolved from intermittent toward real-time measurements and from invasive toward less invasive approaches. Nowadays, echocardiography is recommended as the first-line modality of hemodynamic evaluation in patients with shock. Current guidelines recommend reserving advanced hemodynamic monitoring systems for patients not responding to the initial therapy and/or for complex conditions such as combination of shock with acute respiratory distress syndrome. Invasive and noninvasive uncalibrated cardiac output monitors, as well as esophageal Doppler, could find their place in the perioperative context rather than in patients with shock.

Summary The use of echocardiography should be encouraged at the initial period of shock to identify main involved mechanisms and to select the appropriate therapy. The use of more invasive monitoring systems should be discussed on an individualized basis.

aHôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale

bINSERM UMR S 999, Univ Paris-Sud, Le Kremlin-Bicêtre, France

Correspondence to Professor Jean-Louis Teboul, Service de réanimation médicale, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270 France. Tel: +33 145213543; e-mail: jean-louis.teboul@aphp.fr

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