The Meaning of Hemodynamic Monitoring in Patients with Shock: Role of Echocardiography

Abstract

The development of noninvasive devices to manage hemodynamics in patients with shock is directly prompted by the results of recent studies in the intensive care unit (ICU), and during the perioperative period, which demonstrated the inability of an invasive approach, based on right heart catheterization, to improve prognosis [1]. Some authors have suggested that these results were largely due to inaccurate use of right heart catheterization, without clear goals or protocol [2], However, previous studies have demonstrated that optimization of cardiac output and mixed venous oxygen saturation (SvO₂) with clear endpoints also fails to improve prognosis [3]. So, the lack of efficacy is inherent in the device. In 1985, Eugene Robin suggested that using right heart catheterization in patients with shock led physicians to give fluids plus diuretics whatever the wedge pressure [4]. In 2003, Francois Jardin claimed that we were going to move from the “age of oil lamps” to the “age of elec-tricity” [5]. In fact, we are going to change our practices in the management of shock, from an invasive and quantitative approach of hemodynamics to a non-invasive one, more functional and especially qualitative, mainly thanks to the use of echocardiography. This leads us to think about the meaning of hemodynamic monitoring.