Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine

Abstract

ObjectiveCirculatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock.MethodsThe European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575–590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit? (2) Should we monitor preload and fluid responsiveness in shock? (3) How and when should we monitor stroke volume or cardiac output in shock? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock? Four types of statements were used: definition, recommendation, best practice and statement of fact.ResultsForty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring.ConclusionsThis consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…This evaluation should start with a thorough clinical examination and evaluation of available physiologic variables that can describe the patient's clinical state (heart rate, blood pressure, arterial oxygen saturation, respiratory rate, temperature, urine output, and others as available). Echocardiography in recent years has become available to many bedside clinicians and enables a more detailed assessment of the causes of the hemodynamic issues [22].…”

“…The use of CVP alone to guide fluid resuscitation can no longer be justified [22] because the ability to predict a response to a fluid challenge when the CVP is within a relatively normal range (8-12 mm Hg) is limited [23]. The same holds true for other static measurements of right or left heart pressures or volumes.…”

“…A recent multicenter study demonstrated limited use of cardiac function monitors during fluid administration in the ICUs. Even though data on the use of these monitors in the emergency department are lacking, the availability of the devices and applicability of the parameters to all situations may influence the routine use of dynamic indices [22,25].…”

Comments on Cecconi et al.: Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine

“…Dear Editor, We read the valuable and interesting ''Consensus on circulatory shock and hemodynamic monitoring'' by Cecconi et al [1]. We remarked the importance of their work, which provides us with recommendations for the ideal approach for patients with this condition.…”

Cardiac output monitoring: less invasiveness, less accuracy?

“…Advanced hemodynamic monitoring using technologies allowing the assessment of stroke volume and thus CO is therefore highly recommended in these patients [1][2][3].…”