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Review
. 2024 Sep 10;13(18):5344.
doi: 10.3390/jcm13185344.

Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit

Camilo Pérez  1   2 , Diana Diaz-Caicedo  1   2 , David Fernando Almanza Hernández  1   2 , Lorena Moreno-Araque  1   2 , Andrés Felipe Yepes  1   2 , Jorge Armando Carrizosa Gonzalez  1   2
Affiliations
Review

Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit

Camilo Pérez et al. J Clin Med. .

Abstract

Shock is a life-threatening condition that requires prompt recognition and treatment to prevent organ failure. In the intensive care unit, shock is a common presentation, and its management is challenging. Critical care ultrasound has emerged as a reliable and reproducible tool in diagnosing and classifying shock. This comprehensive review proposes an ultrasound-based protocol for the hemodynamic assessment of shock to guide its management in the ICU. The protocol classifies shock as either low or high cardiac index and differentiates obstructive, hypovolemic, cardiogenic, and distributive etiologies. In distributive shock, the protocol proposes a hemodynamic-based approach that considers the presence of dynamic obstruction, fluid responsiveness, fluid tolerance, and ventriculo-arterial coupling. The protocol gives value to quantitative measures based on critical care ultrasound to guide hemodynamic management. Using critical care ultrasound for a comprehensive hemodynamic assessment can help clinicians diagnose the etiology of shock and define the appropriate treatment while monitoring the response. The protocol's use in the ICU can facilitate prompt recognition, diagnosis, and management of shock, ultimately improving patient outcomes.

Keywords: cardiac output; fluid responsiveness; hemodynamic monitoring; hemodynamic shock; point-of-care ultrasound; ventriculo-arterial coupling.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Hemodynamic profile of acute circulatory failure based on ultrasound. CI: cardiac index; CO: cardiac output; IVC: inferior vena cava; LVOT: left ventricle outflow tract; PAOP: pulmonary artery occlusion pressure; PLR: passive leg raising; RV: right ventricle; RVOT: right ventricle outflow tract; VTI: velocity–time integral.
Figure 2
Figure 2
Low cardiac index shock algorithm. Obstructive shock causes. CI: cardiac index; RV: right ventricle.
Figure 3
Figure 3
Low cardiac index shock algorithm: cardiogenic and hypovolemic shock. CI: cardiac index; CT: computed tomography; IVC: inferior vena cava; LV: left ventricle; PAOP: pulmonary artery occlusion pressure; PAPS: pulmonary artery systolic pressure; PVR: pulmonary vascular resistance; RV: right ventricle; RVOT: right ventricle outflow tract; SVRI: systemic vascular resistance index; VTI: velocity–time integral.
Figure 4
Figure 4
High cardiac index shock algorithm. CI: cardiac index; LVOT: left ventricle outflow tract; IVC: inferior vena cava; CO: cardiac output; PLR: passive leg raising; Ea: arterial elastance; Ees: left ventricular end-systolic elastance; RV: right ventricle.
See this image and copyright information in PMC

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