Cardiopulmonary monitoring in low-resource settings

PURPOSE OF REVIEW: To discuss cardiopulmonary monitoring strategies during resuscitation of shock in resource-limited settings. RECENT FINDINGS: Despite substantial advances in critical care over recent decades, major disparities in access to cardiopulmonary monitoring persist worldwide. In resource-limited settings, shock management must rely on the optimal use of basic monitoring, including clinical examination and low-cost physiological surrogates of cardiac output and tissue oxygenation. However, each of these tools has important limitations and no single variable accurately predicts fluid responsiveness or tissue perfusion. Evidence supporting routine use of more complex indices, such as central venous oxygen saturation or venous-arterial carbon dioxide difference, has been challenged by lack of efficacy. Recent trials highlight the feasibility of physiology-driven, personalized resuscitation strategies; however, the results need careful interpretation. SUMMARY: Cardiopulmonary monitoring during shock resuscitation in resource-limited settings should prioritize a pragmatic, physiology-based integration of available monitoring tools. Future research must focus on validating simple, affordable strategies and defining context-adapted approaches capable of improving outcomes in these vulnerable populations.