Monitoring: from cardiac output monitoring to echocardiography.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Mathieu
M
Jozwiak
Xavier
X
Monnet
Jean-Louis
JL
Teboul
D001785:Blood Gas Monitoring, Transcutaneous / Q000379:methods*; D002302:Cardiac Output; D016638:Critical Illness / Q000628:therapy*; D004562:Electrocardiography; D006439:Hemodynamics; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012769:Shock / Q000097:blood / Q000503:physiopathology / Q000628:therapy*