Top

Intensive Care Medicine

Published in:

01-05-2008 | Review

What type of monitoring has been shownto improve outcomes in acutely ill patients?

Authors: Gustavo A. Ospina-Tascón, Ricardo L. Cordioli, Jean-Louis Vincent

Published in: Intensive Care Medicine | Issue 5/2008

Abstract

Objective

Lack of evidence that some monitoring systems can improve outcomes has raised doubts about their use in the intensive care unit (ICU). The objective of this study was to determine which monitoring techniques have been shown to improve outcomes in ICU patients.

Design

Comprehensive literature review.

Methods

We conducted a highly sensitive search, up to June 2006, in the Cochrane Central Register of Controlled Trials (CENTRAL) and MedLine, for prospective, randomized controlled trials (RCTs) conducted in adult patients in the ICU and the operating room (major surgical procedures) and focusing on the impact of monitoring on outcome.

Measurements and results

Of 4,175 potential articles, 67 evaluated the impact of monitoring in acutely ill adult patients. There were 40 studies related to hemodynamic monitoring, 17 to respiratory monitoring, and10 to neurological monitoring. Seven studies were classified in two different categories. Positive non-mortality outcomes were observed in 17 of 40 hemodynamic studies, 11 of 17 respiratory, and in all 10 neurological studies. Mortality was evaluated in 31 hemodynamic studies, but a beneficial impact was demonstrated in only 10. For respiratory monitoring, 7 studies evaluated mortality, but only 3 of them showed an improved outcome. We found no neurological monitoring studies that assessed mortality.

Conclusion

There is no broad evidence that any form of monitoring improves outcomes in the ICU and most commonly used devices have not been evaluated by RCT. This review puts into perspective the recent negative studies on the use of the pulmonary artery catheter in the acutely ill.

Available only for authorised users

Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, Brampton W, Williams D, Young D, Rowan K (2005) Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet 366:472–477PubMedCrossRef

Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW (2005) Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. J Am Med Assoc 294:1625–1633CrossRef

Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, DeBoisblanc B, Connors AF Jr, Hite RD, Harabin AL (2006) Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 354:2213–2224PubMedCrossRef

Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186PubMedCrossRef

Niehoff J, DelGuercio C, LaMorte W, Hughes-Grasberger SL, Heard S, Dennis R, Yeston N (1988) Efficacy of pulse oximetry and capnometry in postoperative ventilatory weaning. Crit Care Med 16:701–705PubMedCrossRef

Pearson KS, Gomez MN, Moyers JR, Carter JG, Tinker JH (1989) A cost/benefit analysis of randomized invasive monitoring for patients undergoing cardiac surgery. Anesth Analg 69:336–341PubMedCrossRef

Ruckoldt H, Marx G, Leuwer M, Panning B, Piepenbrock S (1998) Pulse oximetry and capnography in intensive care transportation: combined use reduces transportation risks. Anasthesiol Intensivmed Notfallmed Schmerzther 33:32–36 [in German]PubMed

Venn R, Steele A, Richardson P, Poloniecki J, Grounds M, Newman P (2002) Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth 88:65–71PubMedCrossRef

Bonazzi M, Gentile F, Biasi GM, Migliavacca S, Esposti D, Cipolla M, Marsicano M, Prampolini F, Ornaghi M, Sternjakob S, Tshomba Y (2002) Impact of perioperative haemodynamic monitoring on cardiac morbidity after major vascular surgery in low risk patients. A randomised pilot trial. Eur J Vasc Endovasc Surg 23:445–451PubMedCrossRef

10.

Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, Laporta DP, Viner S, Passerini L, Devitt H, Kirby A, Jacka M (2003) A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 348:5–14PubMedCrossRef

11.

Thomsen HS, Lokkegaard H, Munck O (1987) Influence of normal central venous pressure on onset of function in renal allografts. Scand J Urol Nephrol 21:143–145PubMedCrossRef

12.

Isaacson IJ, Lowdon JD, Berry AJ, Smith RB III, Knos GB, Weitz FI, Ryan K (1990) The value of pulmonary artery and central venous monitoring in patients undergoing abdominal aortic reconstructive surgery: a comparative study of two selected, randomized groups. J Vasc Surg 12:754–760PubMedCrossRef

13.

Joyce WP, Provan JL, Ameli FM, McEwan MM, Jelenich S, Jones DP (1990) The role of central haemodynamic monitoring in abdominal aortic surgery. A prospective randomised study. Eur J Vasc Surg 4:633–636PubMedCrossRef

14.

Berlauk JF, Abrams JH, Gilmour IJ, O'Connor SR, Knighton DR, Cerra FB (1991) Preoperative optimization of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. Ann Surg 214:289–299PubMedCrossRef

15.

Bender JS, Smith-Meek MA, Jones CE (1997) Routine pulmonary artery catheterization does not reduce morbidity and mortality of elective vascular surgery: results of a prospective, randomized trial. Ann Surg 226:229–236PubMedCrossRef

16.

Valentine RJ, Duke ML, Inman MH, Grayburn PA, Hagino RT, Kakish HB, Clagett GP (1998) Effectiveness of pulmonary artery catheters in aortic surgery: a randomized trial. J Vasc Surg 27:203–211PubMedCrossRef

17.

Schultz RJ, Whitfield GF, LaMura JJ, Raciti A, Krishnamurthy S (1985) The role of physiologic monitoring in patients with fractures of the hip. J Trauma 25:309–316PubMed

18.

Guyatt G, Ontario Intensive Care Study Group (1991) A randomized control trial of right heart catheterization in critically ill patients. J Intensive Care Med 6:91–95PubMed

19.

Rhodes A, Cusack RJ, Newman PJ, Grounds M, Bennett D (2002) A randomised, controlled trial of the pulmonary artery catheter in critically ill patients. Intensive Care Med 28:256–264PubMedCrossRef

20.

Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, Boulain T, Lefort Y, Fartoukh M, Baud F, Boyer A, Brochard L, Teboul JL (2003) Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. J Am Med Assoc 290:2713–2720CrossRef

21.

Eisenberg PR, Hansrough JR, Anderson D, Schuster DP (1987) A prospective study of lung water measurements during patient management in an intensive care unit. Am Rev Respir Dis 136:662–668PubMed

22.

Mitchell JP, Schuller D, Calandrino FS, Schuster DP (1992) Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis 145:990–998PubMed

23.

Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. Br Med J 315:909–912

24.

Conway DH, Mayall R, Abdul-Latif MS, Gilligan S, Tackaberry C (2002) Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia 57:845–849PubMedCrossRef

25.

Wakeling HG, McFall MR, Jenkins CS, Woods WG, Miles WF, Barclay GR, Fleming SC (2005) Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth 95:634–642PubMedCrossRef

26.

Gan TJ, Soppitt A, Maroof M, el Moalem H, Robertson KM, Moretti E, Dwane P, Glass PS (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 97:820–826PubMedCrossRef

27.

Mythen MG, Webb AR (1995) Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 130:423–429PubMed

28.

Mohsenifar Z, Hay A, Hay J (1993) Gastric intramural pH as a predictor of success or failure in weaning patients from mechanical ventilation. Ann Intern Med 119:794–798PubMed

29.

Roumen RM, Vreugde JP, Goris RJ (1994) Gastric tonometry in multiple trauma patients. J Trauma 36:313–316PubMed

30.

Doglio GR, Pusajo JF, Egurrola MA, Bonfigli GC, Parra C, Vetere L, Hernandez MS, Fernandez S, Palizas F, Gutierrez G (1991) Gastric mucosal pH as a prognostic index of mortality in critically ill patients. Crit Care Med 19:1037–1040PubMedCrossRef

31.

Gutierrez G, Palizas F, Doglio G, Wainsztein N, Gallesio A, Pacin J, Dubin A, Schiavi E, Jorge M, Pusajo J, Klein F, San Roman E, Dorfman B, Shottlender J, Giniger R (1992) Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 339:195–199PubMedCrossRef

32.

Ivatury RR, Simon RJ, Islam S, Fueg A, Rohman M, Stahl WM (1996) A prospective randomized study of end points of resuscitation after major trauma: global oxygen transport indices versus organ-specific gastric mucosal pH. J Am Coll Surg 183:145–154PubMed

33.

Pargger H, Hampl KF, Christen P, Staender S, Scheidegger D (1998) Gastric intramucosal pH-guided therapy in patients after elective repair of infrarenal abdominal aneurysms: Is it beneficial? Intensive Care Med 24:769–776PubMedCrossRef

34.

Gomersall CD, Joynt GM, Freebairn RC, Hung V, Buckley TA, Oh TE (2000) Resuscitation of critically ill patients based on the results of gastric tonometry: a prospective, randomized, controlled trial. Crit Care Med 28:607–614PubMedCrossRef

35.

Miami Trauma Clinical Trials Group (2005) Splanchnic hypoperfusion-directed therapies in trauma: a prospective, randomized trial. Am Surg 71:252–260

36.

Jastremski MS, Chelluri L, Beney KM, Bailly RT (1989) Analysis of the effects of continuous on-line monitoring of mixed venous oxygen saturation on patient outcome and cost-effectiveness. Crit Care Med 17:148–153PubMedCrossRef

37.

Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333:1025–1032PubMedCrossRef

38.

Ziegler DW, Wright JG, Choban PS, Flancbaum L (1997) A prospective randomized trial of preoperative “optimization” of cardiac function in patients undergoing elective peripheral vascular surgery. Surgery 122:584–592PubMedCrossRef

39.

Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J (2000) A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 90:1052–1059PubMedCrossRef

40.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRef

41.

Boyd O, Grounds M, Bennett ED (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. J Am Med Assoc 270:2699–2707CrossRef

42.

Bishop MH, Shoemaker WC, Appel PL, Meade P, Ordog GJ, Wasserberger J, Wo CJ, Rimle DA, Kram HB, Umali R et al. (1995) Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 38:780–787PubMed

43.

Wilson J, Woods I, Fawcett J, Whall R, Dibb W, Morris C, McManus E (1999) Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. Br Med J 318:1099–1103

44.

Durham RM, Neunaber K, Mazuski JE, Shapiro MJ, Baue AE (1996) The use of oxygen consumption and delivery as endpoints for resuscitation in critically ill patients. J Trauma 41:32–39PubMed

45.

Velmahos GC, Demetriades D, Shoemaker WC, Chan LS, Tatevossian R, Wo CC, Vassiliu P, Cornwell EE III, Murray JA, Roth B, Belzberg H, Asensio JA, Berne TV (2000) Endpoints of resuscitation of critically injured patients: Normal or supranormal? A prospective randomized trial. Ann Surg 232:409–418PubMedCrossRef

46.

Moller JT, Jensen PF, Johannessen NW, Espersen K (1992) Hypoxaemia is reduced by pulse oximetry monitoring in the operating theatre and in the recovery room. Br J Anaesth 68:146–150PubMedCrossRef

47.

Bierman MI, Stein KL, Snyder JV (1992) Pulse oximetry in the postoperative care of cardiac surgical patients. A randomized controlled trial. Chest 102:1367–1370PubMedCrossRef

48.

Moller JT, Svennild I, Johannessen NW, Jensen PF, Espersen K, Gravenstein JS, Cooper JB, Djernes M, Johansen SH (1993) Perioperative monitoring with pulse oximetry and late postoperative cognitive dysfunction. Br J Anaesth 71:340–347PubMedCrossRef

49.

Moller JT, Pedersen T, Rasmussen LS, Jensen PF, Pedersen BD, Ravlo O, Rasmussen NH, Espersen K, Johannessen NW, Cooper JB (1993) Randomized evaluation of pulse oximetry in 20,802 patients: I. Design, demography, pulse oximetry failure rate, and overall complication rate. Anesthesiology 78:436–444PubMedCrossRef

50.

Ochroch EA, Russell MW, Hanson WC III, Devine GA, Cucchiara AJ, Weiner MG, Schwartz SJ (2006) The impact of continuous pulse oximetry monitoring on intensive care unit admissions from a postsurgical care floor. Anesth Analg 102:868–875PubMedCrossRef

51.

Helm M, Schuster R, Hauke J, Lampl L (2003) Tight control of prehospital ventilation by capnography in major trauma victims. Br J Anaesth 90:327–332PubMedCrossRef

52.

Amato MB, Barbas CS, Medeiros DM, Schettino GP, Lorenzi FG, Kairalla RA, Deheinzelin D, Morais C, Fernandes EO, Takagaki TY (1995) Beneficial effects of the “open lung approach” with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation. Am J Respir Crit Care Med 152:1835–1846PubMed

53.

Carvalho CR, Barbas CS, Medeiros DM, Magaldi RB, Lorenzi FG, Kairalla RA, Deheinzelin D, Munhoz C, Kaufmann M, Ferreira M, Takagaki TY, Amato MB (1997) Temporal hemodynamic effects of permissive hypercapnia associated with ideal PEEP in ARDS. Am J Respir Crit Care Med 156:1458–1466PubMed

54.

Amato MB, Barbas CS, Medeiro DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354PubMedCrossRef

55.

Ranieri VM, Suter PM, Tortorella C, Tullio R de, Dayer JM, Brienza A, Bruno F, Slutsky AS (1999) Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. J Am Med Assoc 282:54–61CrossRef

56.

Villar J, Kacmarek RM, Perez-Mendez L, Aguirre-Jaime A (2006) A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med 34:1311–1318PubMedCrossRef

57.

Stewart TE, Meade MO, Cook DJ, Granton JT, Hodder RV, Lapinsky SE, Mazer CD, McLean RF, Rogovein TS, Schouten BD, Todd TR, Slutsky AS, Pressure- and Volume-Limited Ventilation Strategy Group (1998) Evaluation of a ventilation strategy to prevent borotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med 338:355–361PubMedCrossRef

58.

Brochard L, Roudot-Thoraval F, Roupie E, Delclaux C, Chastre J, Fernandez-Mondejar E, Clementi E, Mancebo J, Factor P, Matamis D, Ranieri M, Blanch L, Rodi G, Mentec H, Dreyfuss D, Ferrer M, Brun-Buisson C, Tobin M, Lemaire F (1998) Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med 158:1831–1838PubMed

59.

Brower RG, Shanholtz CB, Fessler HE, Shade DM, White P Jr, Wiener CM, Teeter JG, Dodd-o JM, Almog Y, Piantadosi S (1999) Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med 27:1492–1498PubMedCrossRef

60.

The ARDS Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308CrossRef

61.

Paventi S, Santevecchi A, Metta E, Annetta MG, Perilli V, Sollazzi L, Ranieri R (2001) Bispectral index monitoring in sevoflurane and remifentanil anesthesia. Analysis of drugs management and immediate recovery. Minerva Anestesiol 67:435–439PubMed

62.

Yli-Hankala A, Vakkuri A, Annila P, Korttila K (1999) EEG bispectral index monitoring in sevoflurane or propofol anaesthesia: analysis of direct costs and immediate recovery. Acta Anaesthesiol Scand 43:545–549PubMedCrossRef

63.

Leslie K, Myles PS, Forbes A, Chan MT, Short TG, Swallow SK (2005) Recovery from bispectral index-guided anaesthesia in a large randomized controlled trial of patients at high risk of awareness. Anaesth Intensive Care 33:443–451PubMed

64.

Puri GD, Murthy SS (2003) Bispectral index monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass. Eur J Anaesthesiol 20:451–456PubMedCrossRef

65.

Bauer M, Wilhelm W, Kraemer T, Kreuer S, Brandt A, Adams HA, Hoff G, Larsen R (2004) Impact of bispectral index monitoring on stress response and propofol consumption in patients undergoing coronary artery bypass surgery. Anesthesiology 101:1096–1104PubMedCrossRef

66.

Vretzakis G, Ferdi E, Argiriadou H, Papaziogas B, Mikroulis D, Lazarides M, Bitzikas G, Bougioukas G (2005) Influence of bispectral index monitoring on decision making during cardiac anesthesia. J Clin Anesth 17:509–516PubMedCrossRef

67.

Hachero A, Alamo F, Caba F, Echevarria M, Merino S, Gomez P, Martinez A, Rodriguez R (2001) Influence of bispectral index monitoring on fentanyl requirements during total intravenous anesthesia for major gynecological surgery. Rev Esp Anestesiol Reanim 48:364–369PubMed

68.

Myles PS, Leslie K, McNeil J, Forbes A, Chan MT (2004) Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet 363:1757–1763PubMedCrossRef

69.

Boztug N, Bigat Z, Akyuz M, Demir S, Ertok E (2006) Does using the bispectral index (BIS) during craniotomy affect the quality of recovery? J Neurosurg Anesthesiol 18:1–4PubMedCrossRef

70.

Miner JR, Biros MH, Seigel T, Ross K (2005) The utility of the bispectral index in procedural sedation with propofol in the emergency department. Acad Emerg Med 12:190–196PubMedCrossRef

71.

Eisenberg PR, Jaffe AS, Schuster DP (1984) Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 12:549–553PubMedCrossRef

72.

Saul TG, Ducker TB (1982) Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 56:498–503PubMed

73.

O'Sullivan MG, Statham PF, Jones PA, Miller JD, Dearden NM, Piper IR, Anderson SI, Housley A, Andrews PJ, Midgley S (1994) Role of intracranial pressure monitoring in severely head-injured patients without signs of intracranial hypertension on initial computerized tomography. J Neurosurg 80:46–50PubMed

74.

Stuart GG, Merry GS, Smith JA, Yelland JD (1983) Severe head injury managed without intracranial pressure monitoring. J Neurosurg 59:601–605PubMed

75.

Colohan AR, Alves WM, Gross CR, Torner JC, Mehta VS, Tandon PN, Jane JA (1989) Head injury mortality in two centers with different emergency medical services and intensive care. J Neurosurg 71:202–207PubMedCrossRef

76.

Garlick R, Bihari D (1987) The use of intermittent and continuous recordings of jugular venous bulb oxygen saturation in the unconscious patient. Scand J Clin Lab Invest (Suppl) 188:47–52CrossRef

77.

Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli TA (1991) Continuous monitoring of cerebral oxygenation in acute brain injury: assessment of cerebral hemodynamic reserve. Neurosurgery 29:743–749PubMedCrossRef

78.

Gopinath SP, Robertson CS, Contant CF, Hayes C, Feldman Z, Narayan RK, Grossman RG (1994) Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatry 57:717–723PubMed

79.

Iberti TJ, Fischer EP, Leibowitz AB, Panacek EA, Silverstein JH, Albertson TE (1990) A multicenter study of physician's knowledge of the pulmonary artery catheter. J Am Med Assoc 264:2928–2932CrossRef

80.

Fleming A, Bishop M, Shoemaker WC, Appel P, Sufficool W, Kuvhenguwha A, Kennedy F, Wo CJ (1992) Prospective trial of supranormal values as goals of resuscitation in severe trauma. Arch Surg 127:1175–1181PubMed

81.

Tuchschmidt J, Fried J, Astiz M, Rackow E (1992) Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 102:216–220PubMedCrossRef

82.

Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722PubMedCrossRef

83.

Yu M, Levy MM, Smith P, Takiguchi SA, Miyasaki A, Myers SA (1993) Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study. Crit Care Med 21:830–838PubMed

84.

Ueno S, Tanabe G, Yamada H, Kusano C, Yoshidome S, Nuruki K, Yamamoto S, Aikou T (1998) Response of patients with cirrhosis who have undergone partial hepatectomy to treatment aimed at achieving supranormal oxygen delivery and consumption. Surgery 123:278–286PubMed

85.

Alia I, Esteban A, Gordo F, Lorente JA, Diaz C, Rodriguez JA, Frutos F (1999) A randomized and controlled trial of the effect of treatment aimed at maximizing oxygen delivery in patients with severe sepsis or septic shock. Chest 115:453–461PubMedCrossRef

86.

Lobo SM, Salgado PF, Castillo VG, Borim AA, Polachini CA, Palchetti JC, Brienzi SL, de Oliveira GG (2000) Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med 28:3396–3404PubMedCrossRef

87.

Connors AF, Speroff T, Dawson NV, Thomas C, Harrell FE, Wagner D, Desbiens N, Goldman L, Wu AW, Califf RM, Fulkerson WJ, Vidaillet H, Broste S, Bellamy P, Lynn J, Knaus W, SUPPORT Investigators (1996) The effectiveness of right heart catheterization in the initial care of critically ill patients. J Am Med Assoc 276:889–897CrossRef

88.

Sakr Y, Vincent JL, Reinhart K, Payen D, Wiedermann CJ, Zandstra DF, Sprung CL (2005) Use of the pulmonary artery catheter is not associated with worse outcome in the intensive care unit. Chest 128:2722–2731PubMedCrossRef

89.

Shah MR, Hasselblad V, Stevenson LW, Binanay C, O'Connor CM, Sopko G, Califf RM (2005) Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. J Am Med Assoc 294:1664–1670CrossRef

Title: What type of monitoring has been shownto improve outcomes in acutely ill patients?
Authors: Gustavo A. Ospina-Tascón
Ricardo L. Cordioli
Jean-Louis Vincent
Publication date: 01-05-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0967-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

What type of monitoring has been shownto improve outcomes in acutely ill patients?

Abstract

Objective

Design

Methods

Measurements and results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Methods

Measurements and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2008

Respiratory variations in aortic blood flow predict fluid responsiveness in ventilated children

Aging increases the susceptibility to injurious mechanical ventilation

Is myocardial adrenergic responsiveness depressed in human septic shock?

Vasopressin vs. terlipressinin the treatmentof cardiovascular failure in sepsis

Ventilator-induced lung injury: another sign of aging?

Severity of illness assessment in community-acquired pneumonia