Should we use early less invasive hemodynamic monitoring in unstable ICU patients 英文参考文献.docVIP

Cecconi and Bennett Critical Care 2011,15:173 /content/15/4/173 COMMENTARY Should we use early less invasive hemodynamic monitoring in unstable ICU patients? Maurizio Cecconi and David Bennett* 1 2 See related research by Takala et al., /content/15/3/R148 outc ere may be several explanations for this e Abstract literature on the use of hemodynamic monitoring in improving the outcome of either septic or surgical patients provides two constant features: the use of treatment protocols with speci? c hemodynamic targets and very early application of these protocols. e use of such hemodynamic monitoring is often referred to as early goal-directed therapy (EGDT). In the previous issue of Critical Care, Takala and colleagues presented the results of a multicenter study to investigate whether the early presence of less invasive hemodynamic monitoring improves outcome in patients admitted with hemodynamic instability to the intensive care unit. The authors’results suggest that it makes no di?erence. We discuss these ?ndings and compare them to the literature on early goal-directed therapy in which monitors are used early but with a protocol. In this study, there was no protocolized treatment. ere were qualitative guidelines instead of speci? c hemodynamic targets. e authors acknowledge that this is one of the limitations of the study and that it may explain the lack of a positive result. Interestingly, this lack In the previous issue of Critical Care, Takala and of outcome bene? t when hemodynamic monitoring is colleagues [1] published a multicenter randomized con- used without a protocol is consistent with data in the trolled trial (RCT) investigating the use of less invasive literature. RCTs in which pulmonary artery catheters cardiac output monitoring in