Hemodynamic monitoring is one of the major diagnostic tools
available in the acute care setting to diagnose cardiovascular
insufficiency and monitor changes over time in response to
interventions. However, the rationale and efficacy of hemodynamic
monitoring to affect outcome has come into question. We now have
increasing evidence that outcome from critical illness can be
improved by focused resuscitation based on existing hemodynamic
monitoring, whereas non-specific aggressive resuscitation impairs
survival. Thus, this book frames hemodynamic monitoring into a
functional perspective wherein hemodynamic variables and physiology
interact to derive performance and physiological reserve estimates
that themselves drive treatment. This philosophy, as well as the
limitations and applications of common and evolving hemodynamic
measures and their focused use in the care of critically ill
patients are discussed, relevant to one underlying truth: No
monitoring device, no matter how simple or sophisticated, will
improve patient-centered outcomes useless coupled to a treatment
which, itself, improves outcome.
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