ESICM 2014 — Consensus on Circulatory Shock and Hemodynamic Monitoring
European Society of Intensive Care Medicine, 2014
Shock is defined as life-threatening generalized maldistribution of blood flow resulting in failure of oxygen delivery. Norepinephrine is recommended as the first-choice vasopressor. Dynamic measures of fluid responsiveness (PLR, stroke volume variation) are preferred over static filling pressures.
Clinical Context & Relevant Topics (4)
Disease ReferenceCellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.
The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.
Primary pump failure, SCAI staging (A–E), PAC hemodynamics (CPO, PAPi), inotrope selection, emergent revascularization, and mechanical circulatory support.
Extracardiac mechanical barriers to filling or ejection: Massive PE, Cardiac Tamponade, Tension Pneumothorax, and Auto-PEEP.