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, Gianfranco Meduri, Rui P. Moreno, Christian Putensen, Thomas Stewart, Antoni Torres

Research output: Contribution to journalArticle

328 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)575-590
Number of pages16
JournalIntensive Care Medicine
Volume33
Issue number4
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

Fingerprint

Paris
France
Shock
Consensus
Hemodynamics
Physiologic Monitoring
Critical Care
Convulsive Therapy
Critical Illness
Cardiac Output
Stroke Volume
Hypotension
Pulmonary Artery
Physical Examination
Lactic Acid
Catheters
Perfusion
Physicians

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France, 27-28 April 2006. / Antonelli, Massimo; Levy, Mitchell; Andrews, Peter J.D.; Chastre, Jean; Hudson, Leonard D.; Manthous, Constantine; Meduri, Gianfranco; Moreno, Rui P.; Putensen, Christian; Stewart, Thomas; Torres, Antoni.

In: Intensive Care Medicine, Vol. 33, No. 4, 01.01.2007, p. 575-590.

Research output: Contribution to journalArticle

Antonelli, M, Levy, M, Andrews, PJD, Chastre, J, Hudson, LD, Manthous, C, Meduri, G, Moreno, RP, Putensen, C, Stewart, T & Torres, A 2007, 'Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France, 27-28 April 2006.', Intensive Care Medicine, vol. 33, no. 4, pp. 575-590. https://doi.org/10.1007/s00134-007-0531-4
Antonelli, Massimo ; Levy, Mitchell ; Andrews, Peter J.D. ; Chastre, Jean ; Hudson, Leonard D. ; Manthous, Constantine ; Meduri, Gianfranco ; Moreno, Rui P. ; Putensen, Christian ; Stewart, Thomas ; Torres, Antoni. / Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France, 27-28 April 2006. In: Intensive Care Medicine. 2007 ; Vol. 33, No. 4. pp. 575-590.
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AU - Chastre, Jean

AU - Hudson, Leonard D.

AU - Manthous, Constantine

AU - Meduri, Gianfranco

AU - Moreno, Rui P.

AU - Putensen, Christian

AU - Stewart, Thomas

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