Cardiopulmonary Monitoring of Septic Shock

  • Claude MartinEmail author
  • Gary Duclos
  • Marc Leone
Part of the Lessons from the ICU book series (LEICU)


Optimal resuscitation of septic shock needs to be directed by a hemodynamic monitoring. Fluid responsiveness must be evaluated by dynamic parameters. Monitoring of cardiac output is also recommended. A central venous line, an arterial catheter, and echocardiography are the minimal monitoring required. In case of no response to treatment or concomitant ALI/ARDS, transpulmonary thermodilution should be used in addition to the basic monitoring.


Dynamic parameters of fluid responsiveness Arterial catheter Echocardiography Pulmonary artery catheter Transpulmonary thermodilution 


  1. 1.
    Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795–815.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37:2642–7.CrossRefGoogle Scholar
  3. 3.
    Cavallaro F, Sandroni C, Marano C, et al. Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Med. 2010;36:1475–83.CrossRefPubMedGoogle Scholar
  4. 4.
    Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134:172.CrossRefPubMedGoogle Scholar
  5. 5.
    Levitov A, Frankel HL, Blaivas M, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part II: cardiac ultrasonography. Crit Care Med. 2016;44:1206–27.CrossRefPubMedGoogle Scholar
  6. 6.
    Barbier C, Loubières Y, Schmit C, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. 2004;30:1740–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Spencer KT, Kimura BJ, Korcarz CE, et al. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26:567–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med. 2016;42:1935–47.CrossRefGoogle Scholar
  9. 9.
    Monnet X, Anguel N, Naudin B, et al. Arterial pressure-based cardiac output in septic patients: different accuracy of pulse contour and uncalibrated pressure waveform devices. Crit Care. 2010;14:R109.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Monnet X, Teboul JL. Transpulmonary thermodilution: advantages and limits. Crit Care. 2017;21:147.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Connors AF Jr, Speroff T, Dawson NV, et al. Support Investigators. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA. 1996;276:889–97.CrossRefPubMedGoogle Scholar
  12. 12.
    Pinsky MR, Vincent JL. Let us use the pulmonary artery catheter correctly and only when we need it. Crit Care Med. 2005;33:1119–22.CrossRefPubMedGoogle Scholar
  13. 13.
    Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486–552.CrossRefGoogle Scholar
  14. 14.
    The PRISM investigators. Early, goal-directed therapy for septic shock – a patient-level meta-analysis. N Engl J Med. 2017;376:2223–34.CrossRefGoogle Scholar
  15. 15.
    Hernandez G, Teboul JL. Fourth surviving sepsis campaign’s hemodynamic recommendations: a step forward or a return to chaos? Crit Care. 2017;21:133.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kiyatkin ME, Bakker J. Lactate and microcirculation as suitable targets for hemodynamic optimization resuscitation of circulatory shock. Curr Opin Crit Care. 2017;23:348–54.CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Intensive Care Medicine 2019

Authors and Affiliations

  1. 1.Aix-Marseille UniversitéMarseilleFrance

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