The need for invasive hemodynamic monitoring has been increasingly challenged, and its use has decreased over the last decade. Other less invasive techniques have been developed, but whether this results in improved outcomes in all patients remains to be seen. Increasingly, continuous, noninvasive, and metabolic monitors are becoming available that may supplant more invasive monitoring devices in resuscitation algorithms. Using functional hemodynamic monitoring to define responsiveness in the optimization of blood flow has been shown to improve outcomes in cardiac surgery patients. website
There is still debate regarding superiority of the available vasopressor agents. We have learned that the maintenance of cardiac output or oxygen delivery at predetermined, supranormal levels does not universally result in better outcomes, although so-called “preoptimization” may be beneficial in high-risk surgical patients, especially when it involves the correction of underlying hypovolemia.
Thrombolytic therapy has been simplified for patients with acute myocardial infarction (AMI), and invasive percutaneous interventions are more commonly applied in acute coronary syndromes in many settings with suitable facilities. For some patients with AMI, prehospital thrombolysis can save lives in appropriate circumstances, particularly when invasive procedures would not be readily available. In critically ill patients, the diagnosis of non-ST-seg-ment elevation myocardial infarction is difficult because ECG changes are common and often nonspecific, and increased troponin levels are also nonspecific, occurring among patients without flow-limiting coronary artery disease. Finally, eliciting classic ischemic symptoms from ICU patients is rarely possible due to decreased level of consciousness from their underlying condition or drug infusions.