What type of monitoring has been shownto improve outcomes in acutely ill patients?

Objective: Lack of evidence that some monitoring systems can improve outcomes has raised doubts about their use in the intensive care unit (ICU). The objective of this study was to determine which monitoring techniques have been shown to improve outcomes in ICU patients. Design: Comprehensive literature review. Methods: We conducted a highly sensitive search, up to June 2006, in the Cochrane Central Register of Controlled Trials (CENTRAL) and MedLine, for prospective, randomized controlled trials (RCTs) conducted in adult patients in the ICU and the operating room (major surgical procedures) and focusing on the impact of monitoring on outcome. Measurements and results: Of 4,175 potential articles, 67 evaluated the impact of monitoring in acutely ill adult patients. There were 40 studies related to hemodynamic monitoring, 17 to respiratory monitoring, and10 to neurological monitoring. Seven studies were classified in two different categories. Positive non-mortality outcomes were observed in 17 of 40 hemodynamic studies, 11 of 17 respiratory, and in all 10 neurological studies. Mortality was evaluated in 31 hemodynamic studies, but a beneficial impact was demonstrated in only 10. For respiratory monitoring, 7 studies evaluated mortality, but only 3 of them showed an improved outcome. We found no neurological monitoring studies that assessed mortality. Conclusion: There is no broad evidence that any form of monitoring improves outcomes in the ICU and most commonly used devices have not been evaluated by RCT. This review puts into perspective the recent negative studies on the use of the pulmonary artery catheter in the acutely ill.