Invasive hemodynamic monitoring-guided resuscitation improves survival in shock: A systematic review and meta-analysis

doi:10.1016/j.aicoj.2026.100071

Invasive hemodynamic monitoring-guided resuscitation improves survival in shock: A systematic review and meta-analysis

Ann Intensive CarePublished 29 Apr 2026Systematic review and meta-analysis of randomised, non-randomised and observational studies

Pooled result · In-hospital mortality, any type of shockResultOdds ratio 0.66 95% CI [0.48; 0.91]

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Authors' conclusion

AHDM use is associated with a significant reduction in mortality in shock patients, with the greatest benefit observed in cardiogenic shock.

Study context

Population: Adult shock patients
Participants: 636,441 patients · 34 studies · 7 RCTs

Comparison: Advanced hemodynamic monitoring (AHDM) vs Conventional monitoring
Outcome: In-hospital and 30-day mortality

Methodological detailsrandom-effects model, Risk of bias predominantly low in RCTs and serious in observational studies

Random-effects model
Risk of bias predominantly low in RCTs and serious in observational studies

Pooled result

In-hospital mortality, any type of shock

Odds ratio

0.66

95% CI [0.48; 0.91]

P = 0.014

AHDM vs Conventional monitoring

OR 0.66 (95% CI [0.48; 0.91]); P = 0.014

As reported in the abstract

Further pooled results

Outcome	← Lower odds with AHDM ←→ Higher odds with AHDM →	OR	P value
In-hospital mortality, cardiogenic shock managed with pulmonary artery catheter-guided therapy (subgroup)	0.20.5125	0.68 (95% CI [0.60; 0.78])	P < 0.001
Need for organ supportAHDM vs Conventional monitoring · inotropes	0.20.5125	2.32 (CI [1.29; 4.19])	P = 0.012
Need for organ supportAHDM vs Conventional monitoring · vasopressors	0.20.5125	1.46 (CI [1.05; 2.04])	P = 0.030
Need for organ supportAHDM vs Conventional monitoring · mechanical circulatory support	0.20.5125	2.85 (CI [1.62; 5.02])	P = 0.002
	0.20.5125Odds ratio (log scale)

Need for organ support

Significantly higher odds of RRT or mechanical ventilation with AHDM

Duration of mechanical ventilation

Shorter with AHDM

Original publication

Invasive hemodynamic monitoring-guided resuscitation improves survival in shock: A systematic review and meta-analysis. Ann Intensive Care. Published 29 April 2026. doi:10.1016/j.aicoj.2026.100071

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