Réanimation

, Volume 24, Issue 2, pp 207–212 | Cite as

Pourquoi ne fais-je pas de monitoring hémodynamique ?

Article de Synthèse / Review Article
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Résumé

Le monitoring hémodynamique a toujours été le sujet de nombreuses controverses en réanimation. Bien que les différents outils d’évaluation hémodynamique aient apporté de précieuses informations physiopathologiques au cours des états de choc, il est aujourd’hui pourtant difficile de les recommander dans notre pratique quotidienne. En dehors des critiques liées à la précision des mesures ou à leur reproductibilité, ces outils n’ont jamais apporté la preuve d’une amélioration pronostique des patients en réanimation. Les raisons de leur échec clinique sont multiples et incluent l’absence d’objectifs hémodynamiques précis à atteindre et l’absence d’intervention thérapeutique consensuelle qui en découle. Plus récemment, les discordances entre les paramètres hémodynamiques globaux comme le débit cardiaque ou la pression artérielle moyenne et la perfusion microcirculatoire ont augmenté le doute quant à leur utilité. Le monitoring de la perfusion tissulaire microcirculatoire au cours des états de choc doit à l’avenir occuper une place plus importante dans la gestion de l’insuffisance circulatoire aiguë.

Mots clés

Monitoring Choc Débit cardiaque Pression artérielle moyenne Microcirculation 

Shock: Why do I not use cardiovascular monitoring?

Abstract

Hemodynamic monitoring has been the subject of many controversies in intensive care unit. Although several monitoring devices have provided interesting pathophysiological information during acute circulatory failure, it is today difficult to recommend their use in daily practice. Outside criticisms related to measurement accuracy or reproducibility, no study has clearly shown that these monitoring tools improved the prognosis of critically ill patients. The reasons for their clinical failure are many and include a lack of clear hemodynamic goals to achieve and a lack of consensus resulting from therapeutic intervention. More recently, discrepancies between global hemodynamic parameters such as heart rate or mean arterial pressure and microcirculatory perfusion increased doubt on their usefulness. Monitoring of microcirculatory tissue perfusion during shock states must in the future have a more important place in the management of acute circulatory failure.

Keywords

Cardiovascular monitoring Shock Cardiac output Mean arterial blood pressure Microcirculation 
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Copyright information

© Société de réanimation de langue française (SRLF) and Springer-Verlag France 2015

Authors and Affiliations

  1. 1.AP-HP, hôpital Saint-Antoine, service de réanimation médicaleUniversité Pierre et Marie Curie-Paris 6Paris cedex 12France
  2. 2.Inserm U970centre de recherche cardiovasculaire de Paris (PARCC)ParisFrance
  3. 3.Inserm U707ParisFrance

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