Cardiogenic shock monitoring

Patients with cardiogenic shock exhibit two diffe- rent clinical scenarios: the classical, which associates severe hypokinetic shock and elevated pulmonary pressures, and the new scenario in which severe myocardial depression is asso- ciated with low systemic resistances. Individualized pulmo- nary artery catheter use is recommended for severely hypo- tensive cardiogenic shock patients. Clinical assessment with echocardiography is a reasonable alternative in the less severe patients. Transpulmonary thermodilution associated with continuous measurement of mixed venous oxygen saturation (SvO2) is a reasonable alternative in others. Measurements of SvO2, arterial lactate concentration, and venous-arterial pCO2 differenceare reliabletoassesstissue oxygenation andmacro- circulation. Brain natriuretic peptide (BNP) could be useful to monitor the effects of medications on ventricular dysfunction. To cite this journal: Reanimation 21 (2012).