Principals of hemodynamic monitoring.
OBJECTIVE
Hemodynamic monitoring is the cornerstone of patient management in the intensive care unit. However, to be used effectively its applications and limitations need to be defined and its values applied within the context of proven therapeutic approaches.


METHODS
Review of the physiological basis for monitoring and a review of the literature on its utility in altering patient outcomes.


RESULTS
Most forms of monitoring are used to prevent cardiovascular deterioration or restore cardiovascular wellness. However, little data support the generalized use of aggressive resuscitation protocols in all but the most acutely ill prior to the onset of organ injury. Outcomes improve with aggressive resuscitation in some patients presenting with early severe sepsis and in postoperative high-risk surgical patients.


CONCLUSIONS
Monitoring should be targeted to meet the specific needs of the patient and should not be applied in a broad fashion and whenever possible it should be used as part of a treatment protocol of proven efficacy.
Polanco
Patricio M
PM
Division of Trauma, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
Pinsky
Michael R
MR
D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology; D002319:Cardiovascular System / Q000503:physiopathology; D002496:Central Venous Pressure / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000379:methods*; D011669:Pulmonary Wedge Pressure; D012151:Resuscitation