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


METHODS
The 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.


RESULTS
Forty-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.


CONCLUSIONS
This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock.
Anaesthesia and Intensive Care, St George's Hospital and Medical School, SW17 0QT, London, UK, mcecconi@sgul.ac.uk.
Maurizio
M
Cecconi
Daniel
D
De Backer
Massimo
M
Antonelli
Richard
R
Beale
Jan
J
Bakker
Christoph
C
Hofer
Roman
R
Jaeschke
Alexandre
A
Mebazaa
Michael R
MR
Pinsky
Jean Louis
JL
Teboul
Jean Louis
JL
Vincent
Andrew
A
Rhodes
D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology; D003422:Critical Care / Q000592:standards*; D004452:Echocardiography; D005060:Europe; D017408:Guidelines as Topic; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008991:Monitoring, Physiologic / Q000592:standards*; D012772:Shock, Septic / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D012955:Societies, Medical / Q000592:standards*; D013318:Stroke Volume / Q000502:physiology