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Abstract

Since the beginning of modern anesthesia, in 1846, the anesthetist has relied on his natural senses to monitor the patient, aided more recently by simple technical devices such as the stethoscope. There has been a tremendous increase in the availability of monitoring devices in the past 30 years. Modern technology has provided a large number of sophisticated monitors and therapeutic instruments, particularly in the past decade. Most of these techniques have enhanced our understanding of the mechanism of the patients' decompensation and have helped to guide appropriate therapeutic interventions. As surgery and critical care medicine have developed rapidly, patient monitoring capability has become increasingly complex. The most important aspect in monitoring the critically ill patient is the detection of life-threatening derangements of vital functions. Aggressive marketing strategies have been promoted to monitor almost every aspect of the patient's status. However, these strategies are only telling us what is possible; they do not tell us whether they enhance patient safety, improve our therapy, or even improve patient outcome.

A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: Part 1: definitions, conservative management and contrast-induced nephropathy

“…Such goal-directed therapy includes avoiding hypotension, optimizing oxygen delivery and careful fluid and vasopressor management when indicated [33]. Some clinical studies have highlighted the need to keep mean arterial blood pressure above 65 mmHg in critically ill patients, but the speed of intervention seems to be very important as well [34]. …”

Limitations of global end-diastolic volume index as a parameter of cardiac preload in the early phase of severe sepsis: a subgroup analysis of a multicenter, prospective observational study

“…They suggested that adequate LV stroke output can be maintained through acute compensatory LV dilatation despite a severely depressed LVEF, which was calculated using radionuclide cineangiography. The methods used for evaluating cardiac preload and LVEF in sepsis patients have changed from cineangiography to pulmonary artery catheterization, echocardiography, and TD; these methods can be used to obtain accurate LV volume measurements at the bedside [ 30 ]. Although Parker et al demonstrated 100% LV dilatation (from 100 to 200 mL) in patients with systolic dysfunction using cineangiography [ 5 ], other investigators have reported that the rate of increase in LV end-diastolic volume is less than 20% using echocardiography [ 3 , 6 ].…”

Contemporary perioperative haemodynamic monitoring

“…Traditional clinical assessment of tissue perfusion includes monitoring urine output, skin temperature, and capillary refill time, but all of these are characterized as insensitive and responsive with delay. Lactate is the most important indicator of hypoxic metabolism and low perfusion state [6,7] but is a non-continuous parameter. In addition, lactate levels can be influenced by lactate-buffered fluids [8].…”