Hemodynamic interventions and -monitoring in critically ill patients

Hemodynamic interventions and - monitoring are daily practices in the Intensive Care Unit (ICU); usually initiated on the basis of (supposed) pathophysiological mechanisms or expert opinion. The available evidence for inotropics in critically ill patients with cardiac dysfunction is hampered by systematic and random errors and does not support contemporary practice. It leaves the clinician with many questions. The only logical conclusion is that if inotropy is given, we should measure the one parameter it is supposed to have a direct effect on: the cardiac output. It probably doesn't matter much which device/instrument is used to measure the cardiac output, although ultrasound has an advantage over other hemodynamic monitoring techniques as it gives a direct impression of the cardiac function and can give possible origins of cardiac dysfunction. Ultrasound will most likely be used more and more in the ICU, as it can quickly provide answers to (binary) questions. For example, it seems to be better able to assess whether there is pulmonary edema compared to a physical examination. However, one should be aware of the operator dependence of ultrasonography and the operator of the ultrasound machine should be aware of the pitfalls of ultrasonography. Hopefully in the near future there will be evidence on patient-relevant outcomes for the use of ultrasound in the ICU