Clinical review: hemodynamic monitoring in the intensive care unit

Abstract

Since the beginning of modern anesthesia, in 1846, the anesthetist has relied on his natural senses to monitor the patient, aided more recently by simple technical devices such as the stethoscope. There has been a tremendous increase in the availability of monitoring devices in the past 30 years. Modern technology has provided a large number of sophisticated monitors and therapeutic instruments, particularly in the past decade. Most of these techniques have enhanced our understanding of the mechanism of the patients' decompensation and have helped to guide appropriate therapeutic interventions. As surgery and critical care medicine have developed rapidly, patient monitoring capability has become increasingly complex. The most important aspect in monitoring the critically ill patient is the detection of life-threatening derangements of vital functions. Aggressive marketing strategies have been promoted to monitor almost every aspect of the patient's status. However, these strategies are only telling us what is possible; they do not tell us whether they enhance patient safety, improve our therapy, or even improve patient outcome.

Figure 1

Odds ratio and 95% confidence interval for studies (total of 1031 patients) attempting to improve tissue perfusion after onset of tissue hypoxic can be expected. No beneficial effect on mortality was seen. (Modified from [30].)

Figure 2

Odds ratio and 95% confidence interval for studies (total of 662 patients) attempting to improve tissue perfusion before onset of tissue hypoxic can be expected. Beneficial effect on mortality were seen. (Modified from [30].)

Figure 3

Use of the pulmonary artery catheter and transesophageal echocardiography (TEE) in the intensive care unit patient. PAP, pulmonary artery pressure; CO, cardiac output; SvO₂, mixed venous oxygen saturation. (Modified from [43].)