Not All Patients with Shock Need an Arterial Catheter

In many intensive care units (ICUs), it is standard practice to place an arterial catheter for close blood pressure monitoring in patients with shock. The belief is that this will allow more rapid and nuanced treatment of hypotension; however, there are limited data that demonstrate better outcomes.

To evaluate whether a noninvasive strategy would be noninferior to catheter placement, French investigators randomized 1000 patients (mostly nonsurgical, from 9 ICUs) with hypotension and evidence of tissue hypoperfusion to either early arterial catheterization (within 4 hours of enrollment) or noninvasive blood pressure monitoring (see Figure 1). All patients were enrolled within 24 hours of ICU admission. More than half had septic shock,…