Septic shock in ICU: Update in hemodynamic monitoring

Abstract

In recent decades, new and important concepts have emerged for the diagnosis and management of the pediatric patient with septic shock, although the basic principles have remained similar over time. Attending physicians in the pediatric intensive care unit (PICU) must be fully aware of these concepts in order to improve patient care in the critical care unit. Hemodynamic monitoring is a tool that not only allows detection of the source of hemodynamic instability but also guides treatment and assesses its effectiveness. Fluid loading is considered the fi rst step in the resuscitation of hemodynamically unstable patients. Nevertheless, clinical determination of the intravascular volume can be extremely diffi cult in a critically ill patient. Studies performed have demonstrated that cardiac fi lling pressures are unable to predict fl uid responsiveness. Dynamic tests of volume responsiveness use the change in stroke volume during mechanical ventilation assessing the patients’ Frank-Starling curve. Through fl uid challenge the clinician can assess whether the patient has a preload reserve that can be used to increase the stroke volume. In this review we updated the available information on basic and functional hemodynamic monitoring.