The Diagnosis and Hemodynamic Monitoring of Circulatory Shock: Current and Future Trends

Abstract

Circulatory shock is a complex clinical syndrome encompassing a group of conditions that can arise from different etiologies and presented by several different hemodynamic patterns. If not corrected, cell dysfunction, irreversible multiple organ insufficiency, and death may occur. The four basic types of shock, hypovolemic, cardiogenic, obstructive and distributive, have features similar to that of hemodynamic shock. It is therefore essential, when monitoring hemodynamic shock, to making accurate clinical assessments which will guide and dictate appropriate management therapy. The European Society of Intensive Care has recently made recommendations for monitoring hemodynamic shock. The present paper discusses the issues raised in the new statements, including individualization of blood pressure targets, prediction of fluid responsiveness, and the use of echocardiography as the first means during the initial evaluation of circulatory shock. Also, the place of more invasive hemodynamic monitoring techniques and future trends in hemodynamic and metabolic monitoring in circulatory shock, will be debated.

Keywords: circulatory shock; future trends; hemodynamic shock; new statements; transesophageal echocardiography.

Fig. 1

The three main cross-sectional views with ImaCor – hemodynamic transesophageal echocardiography (h-TEE) probe. LV: left ventricle, RA right atrium, LA: left atrium, RV: right ventricle, RPA: right pulmonary artery, SVC: superior vena cava, Ao: aorta (ascending aorta)