Saugel Bernd, Malbrain Manu L N G, Perel Azriel
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Intensive Care, Ziekenhuis Netwerk Antwerpen, Campus ZNA Stuivenberg, Antwerp, Belgium.
Crit Care. 2016 Dec 20;20(1):401. doi: 10.1186/s13054-016-1534-8.
Hemodynamic instability frequently occurs in critically ill patients. Pathophysiological rationale suggests that hemodynamic monitoring (HM) may identify the presence and causes of hemodynamic instability and therefore may allow targeting therapeutic approaches. However, there is a discrepancy between this pathophysiological rationale to use HM and a paucity of formal evidence (as defined by the strict criteria of evidence-based medicine (EBM)) for its use. In this editorial, we discuss that this paucity of formal evidence that HM can improve patient outcome may be explained by both the shortcomings of the EBM methodology in the field of intensive care medicine and the shortcomings of HM itself.
血流动力学不稳定在危重症患者中经常发生。病理生理学原理表明，血流动力学监测（HM）可能识别出血流动力学不稳定的存在及其原因，因此可能有助于确定治疗方法。然而，使用HM的这一病理生理学原理与缺乏关于其使用的正式证据（按照循证医学（EBM）的严格标准定义）之间存在差异。在这篇社论中，我们讨论了HM能够改善患者预后的正式证据的缺乏，可能是由重症监护医学领域EBM方法的缺点以及HM本身的缺点共同导致的。
