Hemodynamic monitoring: a technology assessment. Technology Subcommittee of the Working Group on Critical Care, Ontario Ministry of Health.

OBJECTIVE: To review catheterization of the right side of the heart according to technical capability, diagnostic accuracy, range of possible uses, therapeutic impact, benefit to patient outcome and impact on health care workers. DATA SOURCES: MEDLINE was searched for English-language articles published since 1962. Additional references were selected from the bibliographies of identified articles. STUDY SELECTION: Nonrandomized trials and retrospective reviews were included because of a paucity of randomized controlled trials. DATA EXTRACTION AND SYNTHESIS: After a review of the data on hemodynamic monitoring by the subcommittee members, guidelines were developed through the use of the nominal group and Delphi consensus-gathering techniques. CONCLUSIONS: The use of catheterization of the right side of the heart for hemodynamic monitoring should be reserved for tertiary and secondary care hospitals, which are adequately staffed by physicians and nurses well versed in the use of such monitoring. Future research should be directed at determining whether the use of hemodynamic monitoring will improve outcomes among patients, especially those with myocardial infarction, septic shock or pulmonary edema.