[Evidence on the utility of hemodynamic monitorization in the critical patient].

Hemodynamic monitoring is a tool of great value for the assessment of critically ill patients. It can not only detect and determine the source of hemodynamic instability, but also guide the choice of appropriate treatment and further evaluate its effectiveness. However, monitoring per se is not a therapeutic tool and its use in the absence of a well-defined objective, need not affect patient outcome. To improve outcome, hemodynamic monitoring necessarily must be coupled to a treatment protocol that has effectively been shown to improve outcome. Accordingly, the usefulness of monitoring systems should be evaluated not only on the basis of the accuracy and reliability of their measurements, but also on the ability to positively affect patient outcome. In this regard, many of the arguments against the use of hemodynamic monitoring are a consequence of non-protocolized use and of application not directed towards specific hemodynamic objectives of proven benefit for the patient.