Hemodynamic monitoring in the critically ill

Background: Hemodynamic monitoring is an important issue in the management of shock to restore cardiovascular stability. Many tools were developed for this purpose, which allows guiding interventions and correcting abnormal physiology. Objectives: To review the role of these methods, how to indicate and interpret data obtained with these devices. Methodology: A review of studies that evaluated tools for monitoring of hemodynamic status in critically ill patients. Since the introduction of pulmonary artery catheter (PAC)2 hemodynamic monitoring undergoes a great advance, nowadays allowing to obtain information about the hemodynamic status with less invasive tools. The moment to start hemodynamic monitoring should be before organ failure3 and the physician's ability in interpreting data are crucial for therapeutic success. The physician should seek the answer to four questions at least: (1) when to indicate; (2) know the technique to use the tool; (3) knowing how to interpret the derived information; (4) have a therapeutic plan. Conclusions: Hemodynamic monitoring tools are important in the management of the critically ill. The choice of the appropriate device at the right time, in the right patient, is the first step to have successful management in severe cardiovascular instability.

Author(s): Fernando S Dias

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