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Intensive Care Medicine

, Volume 33, Issue 4, pp 575–590 | Cite as

Hemodynamic monitoring in shock and implications for management

International Consensus Conference, Paris, France, 27–28 April 2006
  • Massimo Antonelli
  • Mitchell Levy
  • Peter J. D. Andrews
  • Jean Chastre
  • Leonard D. Hudson
  • Constantine Manthous
  • G. Umberto Meduri
  • Rui P. Moreno
  • Christian Putensen
  • Thomas Stewart
  • Antoni Torres
International Consensus Conference

Abstract

Objective

Shock is a severe syndrome resulting in multiple organ dysfunction and a high mortality rate. The goal of this consensus statement is to provide recommendations regarding the monitoring and management of the critically ill patient with shock.

Methods

An international consensus conference was held in April 2006 to develop recommendations for hemodynamic monitoring and implications for management of patients with shock. Evidence-based recommendations were developed, after conferring with experts and reviewing the pertinent literature, by a jury of 11 persons representing five critical care societies.

Data synthesis

A total of 17 recommendations were developed to provide guidance to intensive care physicians monitoring and caring for the patient with shock. Topics addressed were as follows: (1) What are the epidemiologic and pathophysiologic features of shock in the ICU? (2) Should we monitor preload and fluid responsiveness in shock? (3) How and when should we monitor stroke volume or cardiac output in shock? (4) What markers of the regional and micro-circulation can be monitored, and how can cellular function be assessed in shock? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock?

One of the most important recommendations was that hypotension is not required to define shock, and as a result, importance is assigned to the presence of inadequate tissue perfusion on physical examination. Given the current evidence, the only bio-marker recommended for diagnosis or staging of shock is blood lactate.

The jury also recommended against the routine use of (1) the pulmonary artery catheter in shock and (2) static preload measurements used alone to predict fluid responsiveness.

Conclusions

This consensus statement provides 17 different recommendations pertaining to the monitoring and caring of patients with shock. There were some important questions that could not be fully addressed using an evidence-based approach, and areas needing further research were identified.

Keywords

Shock Hemodynamic monitoring ScvO2 Lactate Pulmonary artery catheter Fluid responsiveness 

Supplementary material

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Massimo Antonelli
    • 1
  • Mitchell Levy
    • 2
  • Peter J. D. Andrews
    • 3
  • Jean Chastre
    • 4
  • Leonard D. Hudson
    • 5
  • Constantine Manthous
    • 6
  • G. Umberto Meduri
    • 7
  • Rui P. Moreno
    • 8
  • Christian Putensen
    • 9
  • Thomas Stewart
    • 10
  • Antoni Torres
    • 11
  1. 1.Istituto di Anestesiologia e Rianimazione, Policlinico Universitario A. GemelliUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Rhode Island Hospital & Brown UniversityProvidenceUSA
  3. 3.University of Edinburgh & Western General HospitalEdinburghUK
  4. 4.Hopital Pitié SalpétrièreParisFrance
  5. 5.Harborview Medical CenterSeattleUSA
  6. 6.Bridgeport HospitalBridgeportUSA
  7. 7.University of Tennessee HSCMemphisUSA
  8. 8.Hospital de St. António dos CapuchosLisbonPortugal
  9. 9.Operative Intensivmedizin, Klinik und Poliklinik fuer Anaesthesiologie und operative IntensivmedizinUniversity of BonnBonnGermany
  10. 10.Critical Care MedicineMount Sinai HospitalTorontoCanada
  11. 11.Servei de Pneumologia i Allèrgia RespiratòriaHospital Clínic de BarcelonaBarcelonaSpain

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