TY - JOUR
T1 - ESICM guidelines on circulatory shock and hemodynamic monitoring 2025
AU - Monnet, Xavier
AU - Messina, Antonio
AU - Greco, Massimiliano
AU - Bakker, Jan
AU - Aissaoui, Nadia
AU - Cecconi, Maurizio
AU - Coppalini, Giacomo
AU - De Backer, Daniel
AU - Edul, Vanina Kanoore
AU - Evans, Laura
AU - Hernández, Glenn
AU - Hunsicker, Oliver
AU - Ince, Can
AU - Kaufmann, Thomas
AU - Levy, Bruno
AU - Malbrain, Manu L.N.G.
AU - Mebazaa, Alexandre
AU - Myatra, Sheila Nainan
AU - Ostermann, Marlies
AU - Pinsky, Michael R.
AU - Saugel, Bernd
AU - Savi, Marzia
AU - Singer, Mervyn
AU - Teboul, Jean Louis
AU - Vieillard-Baron, Antoine
AU - Vincent, Jean Louis
AU - Chew, Michelle S.
N1 - Publisher Copyright:
© Springer-Verlag GmbH Germany, part of Springer Nature 2025.
PY - 2025/11
Y1 - 2025/11
N2 - Objective: These European Society of Intensive Care Medicine (ESICM) guidelines provide recommendations for the diagnosis of shock and hemodynamic monitoring for adult critically ill patients. Methods: An international panel of experts formulated PICO-formatted questions, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess evidence and formulate recommendations. In the absence of strong evidence, panelists issued ungraded good practice statements (UGPS). Results: Panelists issued 50 statements. Among others, skin perfusion should be monitored using the assessment of capillary refill time, and this may be complemented by the assessment of skin temperature and mottling (UGPS). In patients with a central venous catheter, serial measurements of (central) venous oxygen saturation and of the veno-arterial difference in carbon dioxide partial pressure should be performed (UGPS). In patients with persistent shock after initial fluid resuscitation, fluid responsiveness should be assessed before continuing fluid resuscitation (UGPS). It is recommended to use dynamic variables over static markers of preload for predicting fluid responsiveness, when applicable (graded statement). Cardiac output (CO) and/or stroke volume should be monitored in patients who do not respond to initial therapy (UGPS). Arterial pressure should be monitored with an arterial catheter in shock that is not responsive to initial therapy and/or requiring vasopressor infusion (UGPS), and central venous pressure should be measured in patients who have a central venous catheter (UGPS). Panelists suggest using echocardiography as the first-line imaging modality to assess the type of shock (graded statement). Echocardiographically defined phenotypes of left and right ventricular dysfunction may be of prognostic significance (UGPS). Conclusions: The panel made 50 recommendations on shock diagnosis and hemodynamic monitoring.
AB - Objective: These European Society of Intensive Care Medicine (ESICM) guidelines provide recommendations for the diagnosis of shock and hemodynamic monitoring for adult critically ill patients. Methods: An international panel of experts formulated PICO-formatted questions, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess evidence and formulate recommendations. In the absence of strong evidence, panelists issued ungraded good practice statements (UGPS). Results: Panelists issued 50 statements. Among others, skin perfusion should be monitored using the assessment of capillary refill time, and this may be complemented by the assessment of skin temperature and mottling (UGPS). In patients with a central venous catheter, serial measurements of (central) venous oxygen saturation and of the veno-arterial difference in carbon dioxide partial pressure should be performed (UGPS). In patients with persistent shock after initial fluid resuscitation, fluid responsiveness should be assessed before continuing fluid resuscitation (UGPS). It is recommended to use dynamic variables over static markers of preload for predicting fluid responsiveness, when applicable (graded statement). Cardiac output (CO) and/or stroke volume should be monitored in patients who do not respond to initial therapy (UGPS). Arterial pressure should be monitored with an arterial catheter in shock that is not responsive to initial therapy and/or requiring vasopressor infusion (UGPS), and central venous pressure should be measured in patients who have a central venous catheter (UGPS). Panelists suggest using echocardiography as the first-line imaging modality to assess the type of shock (graded statement). Echocardiographically defined phenotypes of left and right ventricular dysfunction may be of prognostic significance (UGPS). Conclusions: The panel made 50 recommendations on shock diagnosis and hemodynamic monitoring.
UR - https://www.scopus.com/pages/publications/105021917936
U2 - 10.1007/s00134-025-08137-z
DO - 10.1007/s00134-025-08137-z
M3 - Article
C2 - 41236566
AN - SCOPUS:105021917936
SN - 0342-4642
VL - 51
SP - 1971
EP - 2012
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 11
ER -