Invasive Assessment of the Hemodynamic Profile of Critically Ill Patients: When Is Echocardiographic Assessment Alone Sufficient

Assessing systemic and/or pulmonary congestion in patients with heart failure is fundamental to clinical management and prognosis. This congestive state is characterized by fluid accumulation in the body and represents the leading cause of hospitalization and hospital readmission in heart failure, both in patients with reduced or preserved ejection fraction, and directly contributes to increased mortality. Therefore, the early and accurate identification of fluid overload is indispensable for guiding therapeutic management, preventing complications, and optimizing clinical outcomes. However, conventional clinical signs generally have low sensitivity and specificity, limiting their effectiveness when used alone for disease diagnosis and management and making complementary methods necessary to better define the clinical condition.

Invasive tools to establish hemodynamic parameters are considered the gold standard for accurately determining the degree of congestion, assessing cardiac performance, and evaluating pulmonary and systemic vascular resistance. The use of invasive catheters, particularly right-sided catheters, has increased in recent years and has provided relevant prognostic information to guide appropriate treatment in patients with cardiac dysfunction and other diseases, particularly pulmonary hypertension.

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