Three decades of hemodynamic monitoring (1995-2025): from invasive pressure based hemodynamic profiling to functional physiology.

Purpose of review: Hemodynamic monitoring has undergone a profound transformation over the last 30 years. The field has transitioned from the "standard of care" invasive pulmonary artery catheterization (PAC) toward minimally invasive and noninvasive technologies. This evolution is characterized by a shift in clinical philosophy.

Recent findings: A very strong shift away from the measurement of static pressures and flow defining specific hemodynamic profiles to the assessment of functional physiology and fluid responsiveness characterize the main changes in hemodynamic monitoring over this time interval. This review summarizes the four main milestones, the evidence-based "PAC-wars" and the "Great debate" (1995-2005); the shift to functional hemodynamics and more precise resuscitation (2005-2015), through the rise of goal-directed therapy (GDT) and protocolization based on patient subgroups (2010-2020); to the present where the focus is on noninvasive monitoring, using artificial intelligence (AI) to plumb biosignatures from time series data and focusing on tissue perfusion and end-organ function (2020-2025).

Summary: The use of hemodynamic monitoring to plumb bedside cardiopulmonary status and monitor responses to therapy with the goal of precise and personalized resuscitation focusing on end-organ recovery using advanced minimally-invasive and on-invasive monitors coupled with AI-aided physiological pattern recognition represents the pathway we are on.