ESICM guidelines on circulatory shock and hemodynamic monitoring 2025

Guideline Overview

These guidelines, developed by the European Society of Intensive Care Medicine (ESICM), offer recommendations for identifying shock and performing hemodynamic monitoring in seriously ill adult patients.

Methodology

An international panel of specialists created PICO-formatted questions. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to evaluate evidence and create recommendations. When robust evidence was lacking, the panel provided ungraded good practice statements (UGPS).

Key Recommendations

Skin perfusion assessment, including capillary refill time, skin temperature, and mottling, is advised for monitoring.
For patients with central venous catheters, regularly measure central venous oxygen saturation and the difference in carbon dioxide partial pressure between venous and arterial blood.
In cases of ongoing shock despite initial fluid resuscitation, evaluate fluid responsiveness before proceeding with further fluid administration.
When possible, dynamic indicators of preload are preferable to static markers when predicting fluid responsiveness.
Cardiac output (CO) and/or stroke volume monitoring is recommended for patients who aren't improving with initial treatment.

“In patients with persistent shock after initial fluid resuscitation, fluid responsiveness should be assessed before continuing fluid resuscitation.”

Summary

These ESICM guidelines provide a structured approach to the diagnosis and management of circulatory shock, emphasizing the importance of comprehensive hemodynamic monitoring and individualized patient assessment.

Springer — 2025-11-21

Guideline Overview

Methodology

Key Recommendations

Summary

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