Guidelines
● Rhodes, Andrew MB BS, MD(Res) (Co-chair)1; Evans, Laura E. MD, MSc, FCCM (Co-chair)2; Alhazzani, Waleed MD, MSc, FRCPC (methodology chair)3; Levy, Mitchell M. MD, MCCM4; Antonelli, Massimo MD5; Ferrer, Ricard MD, PhD6; Kumar, Anand MD, FCCM7; Sevransky, Jonathan E. MD, FCCM8; Sprung, Charles L. MD, JD, MCCM9; Nunnally, Mark E. MD, FCCM2; Rochwerg, Bram MD, MSc (Epi)3; Rubenfeld, Gordon D. MD (conflict of interest chair)10; Angus, Derek C. MD, MPH, MCCM11; Annane, Djillali MD12; Beale, Richard J. MD, MB BS13; Bellinghan, Geoffrey J. MRCP14; Bernard, Gordon R. MD15; Chiche, Jean-Daniel MD16; Coopersmith, Craig MD, FACS, FCCM8; De Backer, Daniel P. MD, PhD17; French, Craig J. MB BS18; Fujishima, Seitaro MD19; Gerlach, Herwig MBA, MD, PhD20; Hidalgo, Jorge Luis MD, MACP, MCCM21; Hollenberg, Steven M. MD, FCCM22; Jones, Alan E. MD23; Karnad, Dilip R. MD, FACP24; Kleinpell, Ruth M. PhD, RN-CS, FCCM25; Koh, Younsuck MD, PhD, FCCM26; Lisboa, Thiago Costa MD27; Machado, Flavia R. MD, PhD28; Marini, John J. MD29; Marshall, John C. MD, FRCSC30; Mazuski, John E. MD, PhD, FCCM31; McIntyre, Lauralyn A. MD, MSc, FRCPC32; McLean, Anthony S. MB ChB, MD, FRACP, FJFICM33; Mehta, Sangeeta MD34; Moreno, Rui P. MD, PhD35; Myburgh, John MB ChB, MD, PhD, FANZCA, FCICM, FAICD36; Navalesi, Paolo MD37; Nishida, Osamu MD, PhD38; Osborn, Tiffany M. MD, MPH, FCCM31; Perner, Anders MD39; Plunkett, Colleen M.25; Ranieri, Marco MD40; Schorr, Christa A. MSN, RN, FCCM22; Seckel, Maureen A. CCRN, CNS, MSN, FCCM41; Seymour, Christopher W. MD42; Shieh, Lisa MD, PhD43; Shukri, Khalid A. MD44; Simpson, Steven Q. MD45; Singer, Mervyn MD46; Thompson, B. Taylor MD47; Townsend, Sean R. MD48; Van der Poll, Thomas MD49; Vincent, Jean-Louis MD, PhD, FCCM50; Wiersinga, W. Joost MD, PhD51; Zimmerman, Janice L. MD, MACP, MCCM52; Dellinger, R. Phillip MD, MCCM22 Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016, Critical Care Medicine: March 2017 – Volume 45 – Issue 3 – p 486-552
doi: 10.1097/CCM.0000000000002255
● Davis, Alan L. MD, MPH, FAAP, FCCM1; Carcillo, Joseph A. MD2; Aneja, Rajesh K. MD2; Deymann, Andreas J. MD3; Lin, John C. MD4; Nguyen, Trung C. MD5; Okhuysen-Cawley, Regina S. MD, FAAP5; Relvas, Monica S. MD, FAAP, MSHA, FCCM6; Rozenfeld, Ranna A. MD, FCCM7; Skippen, Peter W. MD, MBBS, FRCPC8; Stojadinovic, Bonnie J. DNP, CPNP9; Williams, Eric A. MD, MS, MMM10; Yeh, Tim S. MD, MCCM11; Balamuth, Fran MD12; Brierley, Joe MD, MA13; de Caen, Allan R. MD14; Cheifetz, Ira M. MD, FCCM15; Choong, Karen MSc, MB, Bch16; Conway, Edward Jr MD, MS, FCCM17; Cornell, Timothy MD18; Doctor, Allan MD19; Dugas, Marc-Andre MD, MSc20; Feldman, Jonathan D. MD21; Fitzgerald, Julie C. MD, PhD22; Flori, Heidi R. MD23; Fortenberry, James D. MD, MCCM24; Graciano, Ana Lia MD, FAAP, FCCM25; Greenwald, Bruce M. MD, FAAP, FCCM26; Hall, Mark W. MD, FCCM27; Han, Yong Yun MD28; Hernan, Lynn J. MD29; Irazuzta, Jose E. MD, FCCM30; Iselin, Elizabeth MD31; van der Jagt, Elise W. MD, MPH, FAAP, SFHM32; Jeffries, Howard E. MD, MBA33; Kache, Saraswati MD34; Katyal, Chhavi MD35; Kissoon, Niranjan (Tex) MD, MCCM, FCCM36; Kon, Alexander A. MD, FCCM37; Kutko, Martha C. MD, FCCM38; MacLaren, Graeme MD, FCCM39–41; Maul, Timothy PhD42; Mehta, Renuka MD, MBBS, FAAP43; Odetola, Fola MD, MPH44; Parbuoni, Kristine BCPS, PharmD45; Paul, Raina MD46; Peters, Mark J. MD, PhD47; Ranjit, Suchitra MD, FCCM48; Reuter-Rice, Karin E. PhD, CPNP-AC, FCCM49; Schnitzler, Eduardo J. MD50; Scott, Halden F. MD51; Torres, Adalberto Jr MD, MS, FCCM52; Weingarten-Abrams, Jacki MD53; Weiss, Scott L. MD24; Zimmerman, Jerry J. MD, PhD, FCCM54; Zuckerberg, Aaron L. MD55,56 American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock, Critical Care Medicine: June 2017 – Volume 45 – Issue 6 – p 1061-1093
doi: 10.1097/CCM.0000000000002425
● Donald M. Yealy, Nicholas M. Mohr, Nathan I. Shapiro, Arjun Venkatesh, Alan E. Jones, Wesley H. Self,Early Care of Adults With Suspected Sepsis in the Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report,Annals of Emergency Medicine,
Volume 78, Issue 1,2021,Pages 1-19,ISSN 0196-0644
● Lawrence G. Rudski, Wyman W. Lai, Jonathan Afilalo, Lanqi Hua, Mark D. Handschumacher, Krishnaswamy Chandrasekaran, Scott D. Solomon, Eric K. Louie, Nelson B. Schiller,
Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography: Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography,
Journal of the American Society of Echocardiography,Volume 23, Issue 7,2010,Pages 685-713,ISSN 0894-7317,
Primary Literature
Fluid Responsiveness
● Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002 Jun;121(6):2000-8. doi: 10.1378/chest.121.6.2000. PMID: 12065368.
● Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med. 2007 Jan;35(1):64-8. doi: 10.1097/01.CCM.0000249851.94101.4F. PMID:
● Bednarczyk JM, Fridfinnson JA, Kumar A, Blanchard L, Rabbani R, Bell D, Funk D, Turgeon AF, Abou-Setta AM, Zarychanski R. Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis. Crit Care Med. 2017 Sep;45(9):1538-1545. doi: 10.1097/CCM.0000000000002554. PMID: 28817481; PMCID: PMC5555977.
● Kattan E, Ospina-Tascón GA, Teboul JL, Castro R, Cecconi M, Ferri G, Bakker J, Hernández G; ANDROMEDA-SHOCK Investigators. Systematic assessment of fluid responsiveness during early septic shock resuscitation: secondary analysis of the ANDROMEDA-SHOCK
● Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Res
● Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009 Sep;37(9):2642-7. doi: 10.1097/
● De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med. 2005 Apr;31(4):517-23. doi: 10.1007/s00134-005-2586-4. Epub 2005 Mar 8. PMID: 1575419
● Biais M, Nouette-Gaulain K, Roullet S, Quinart A, Revel P, Sztark F. A comparison of stroke volume variation measured by Vigileo/FloTrac system and aortic Doppler echocardiography. Anesth Analg. 2009 Aug;109(2):466-9. doi: 10.1213/ane.0b013e3181ac6d
● Dave C, Shen J, Chaudhuri D, Herritt B, Fernando SM, Reardon PM, Tanuseputro P, Thavorn K, Neilipovitz D, Rosenberg E, Kubelik D, Kyeremanteng K. Dynamic Assessment of Fluid Responsiveness in Surgical ICU Patients Through Stroke Volume Variation is
● Duus N, Shogilev DJ, Skibsted S, Zijlstra HW, Fish E, Oren-Grinberg A, Lior Y, Novack V, Talmor D, Kirkegaard H, Shapiro NI. The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing
● Atkinson PR, Milne J, Diegelmann L, Lamprecht H, Stander M, Lussier D, Pham C, Henneberry R, Fraser JM, Howlett MK, Mekwan J, Ramrattan B, Middleton J, van Hoving DJ, Peach M, Taylor L, Dahn T, Hurley S, MacSween K, Richardson LR, Stoica G, Hunter S
● Orso D, Paoli I, Piani T, Cilenti FL, Cristiani L, Guglielmo N. Accuracy of Ultrasonographic Measurements of Inferior Vena Cava to Determine Fluid Responsiveness: A Systematic Review and Meta-Analysis. J Intensive Care Med. 2020 Apr;35(4):354-363. d
Cardiac Output
● Ostergaard M, Nielsen J, Rasmussen JP, Berthelsen PG. Cardiac output–pulse contour analysis vs. pulmonary artery thermodilution. Acta Anaesthesiol Scand. 2006 Oct;50(9):1044-9. doi: 10.1111/j.1399-6576.2006.01080.x. PMID: 16987334.
● Bein B, Worthmann F, Tonner PH, Paris A, Steinfath M, Hedderich J, Scholz J. Comparison of esophageal Doppler, pulse contour analysis, and real-time pulmonary artery thermodilution for the continuous measurement of cardiac output. J Cardiothorac Vas
● Halvorsen PS, Espinoza A, Lundblad R, Cvancarova M, Hol PK, Fosse E, Tønnessen TI. Agreement between PiCCO pulse-contour analysis, pulmonal artery thermodilution and transthoracic thermodilution during off-pump coronary artery by-pass surgery. Acta
● Suttner S, Schöllhorn T, Boldt J, Mayer J, Röhm KD, Lang K, Piper SN. Noninvasive assessment of cardiac output using thoracic electrical bioimpedance in hemodynamically stable and unstable patients after cardiac surgery: a comparison with pulmonary
● Tan HL, Pinder M, Parsons R, Roberts B, van Heerden PV. Clinical evaluation of USCOM ultrasonic cardiac output monitor in cardiac surgical patients in intensive care unit. Br J Anaesth. 2005 Mar;94(3):287-91. doi: 10.1093/bja/aei054. Epub 2005 Jan 1
● Thom O, Taylor DM, Wolfe RE, Cade J, Myles P, Krum H, Wolfe R. Comparison of a supra-sternal cardiac output monitor (USCOM) with the pulmonary artery catheter. Br J Anaesth. 2009 Dec;103(6):800-4. doi: 10.1093/bja/aep296. Epub 2009 Oct 28. PMID: 198
● Gassner M, Killu K, Bauman Z, Coba V, Rosso K, Blyden D. Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods. J Ultrasound. 2014 Nov 12;18(2):127-33. doi: 10.1007/s40477-014-0139-
Tissue Perfusion
● De Backer D, Donadello K, Sakr Y, Ospina-Tascon G, Salgado D, Scolletta S, Vincent JL. Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med. 2013 Mar;41(3):791-9. doi:
● Arnold RC, Dellinger RP, Parrillo JE, Chansky ME, Lotano VE, McCoy JV, Jones AE, Shapiro NI, Hollenberg SM, Trzeciak S. Discordance between microcirculatory alterations and arterial pressure in patients with hemodynamic instability. J Crit Care. 201
● Trzeciak S, McCoy JV, Phillip Dellinger R, Arnold RC, Rizzuto M, Abate NL, Shapiro NI, Parrillo JE, Hollenberg SM; Microcirculatory Alterations in Resuscitation and Shock (MARS) investigators. Early increases in microcirculatory perfusion during pro
● Trzeciak S, Dellinger RP, Parrillo JE, Guglielmi M, Bajaj J, Abate NL, Arnold RC, Colilla S, Zanotti S, Hollenberg SM; Microcirculatory Alterations in Resuscitation and Shock Investigators. Early microcirculatory perfusion derangements in patients w
● Zampieri FG, Damiani LP, Bakker J, Ospina-Tascón GA, Castro R, Cavalcanti AB, Hernandez G. Effects of a Resuscitation Strategy Targeting Peripheral Perfusion Status versus Serum Lactate Levels among Patients with Septic Shock. A Bayesian Reanalysis
● Hernández G, Ospina-Tascón GA, Damiani LP, Estenssoro E, Dubin A, Hurtado J, Friedman G, Castro R, Alegría L, Teboul JL, Cecconi M, Ferri G, Jibaja M, Pairumani R, Fernández P, Barahona D, Granda-Luna V, Cavalcanti AB, Bakker J; The ANDROMEDA SHOCK
Shock Index
● Koch E, Lovett S, Nghiem T, Riggs RA, Rech MA. Shock index in the emergency department: utility and limitations. Open Access Emerg Med. 2019 Aug 14;11:179-199. doi: 10.2147/OAEM.S178358. PMID: 31616192; PMCID: PMC6698590.
● Althunayyan SM. Shock Index as a Predictor of Post-Intubation Hypotension and Cardiac Arrest; A Review of the Current Evidence. Bull Emerg Trauma. 2019 Jan;7(1):21-27. doi: 10.29252/beat-070103.. PMID: 30719462; PMCID: PMC6360014.
● Rau CS, Wu SC, Kuo SC, Pao-Jen K, Shiun-Yuan H, Chen YC, Hsieh HY, Hsieh CH, Liu HT. Prediction of Massive Transfusion in Trauma Patients with Shock Index, Modified Shock Index, and Age Shock Index. Int J Environ Res Public Health. 2016 Jul 5;13(7):
● Olaussen A, Blackburn T, Mitra B, Fitzgerald M. Review article: shock index for prediction of critical bleeding post-trauma: a systematic review. Emerg Med Australas. 2014 Jun;26(3):223-8. doi: 10.1111/1742-6723.12232. Epub 2014 Apr 8. PMID: 2471264
● Liu YC, Liu JH, Fang ZA, Shan GL, Xu J, Qi ZW, Zhu HD, Wang Z, Yu XZ. Modified shock index and mortality rate of emergency patients. World J Emerg Med. 2012;3(2):114-7. doi: 10.5847/wjem.j.issn.1920-8642.2012.02.006. PMID: 25215048; PMCID: PMC412978
Review Articles
● Pinsky MR. Functional haemodynamic monitoring. Curr Opin Crit Care. 2014 Jun;20(3):288-93. doi: 10.1097/MCC.0000000000000090. PMID: 24722057; PMCID: PMC4324536.
● Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 1. Chest. 2005 Aug;128(2):881-95. doi: 10.1378/chest.128.2.881. PMID: 16100182.
● Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 2. Chest. 2005 Sep;128(3):1766-81. doi: 10.1378/chest.128.3.1766. PMID: 16162786.
● Marik PE, Baram M. Noninvasive hemodynamic monitoring in the intensive care unit. Crit Care Clin. 2007 Jul;23(3):383-400. doi: 10.1016/j.ccc.2007.05.002. PMID: 17900477.
● De Backer D, Marx G, Tan A, Junker C, Van Nuffelen M, Hüter L, Ching W, Michard F, Vincent JL. Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients. Intensive Care Med. 2011
● Monnet X, Lahner D. Can the “FloTrac” really track flow in septic patients? Intensive Care Med. 2011 Feb;37(2):183-5. doi: 10.1007/s00134-010-2109-9. Epub 2010 Dec 10. PMID: 21153398.
● Marik PE. Noninvasive cardiac output monitors: a state-of the-art review. J Cardiothorac Vasc Anesth. 2013 Feb;27(1):121-34. doi: 10.1053/j.jvca.2012.03.022. Epub 2012 May 19. PMID: 22609340.
● Saugel B, Cecconi M, Wagner JY, Reuter DA. Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. Br J Anaesth. 2015 Apr;114(4):562-75. doi: 10.1093/bja/aeu447. Epub 2015 Jan 16. PMID: 25596280.
● Trzeciak S, Cinel I, Phillip Dellinger R, Shapiro NI, Arnold RC, Parrillo JE, Hollenberg SM; Microcirculatory Alterations in Resuscitation and Shock (MARS) Investigators. Resuscitating the microcirculation in sepsis: the central role of nitric oxide
● Trzeciak S, Rivers EP. Clinical manifestations of disordered microcirculatory perfusion in severe sepsis. Crit Care. 2005;9 Suppl 4(Suppl 4):S20-6. doi: 10.1186/cc3744. Epub 2005 Aug 25. PMID: 16168070; PMCID: PMC3226160.
● De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002 Jul 1;166(1):98-104. doi: 10.1164/rccm.200109-016oc. PMID: 12091178.
● Michard F, Lopes MR, Auler JO Jr. Pulse pressure variation: beyond the fluid management of patients with shock. Crit Care. 2007;11(3):131. doi: 10.1186/cc5905. PMID: 17521454; PMCID: PMC2206397.
● Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care. 2011 Mar 21;1(1):1. doi: 10.1186/2110-5820-1-1. PMID: 21906322; PMCID: PMC3159904.
Podcasts & Medical Blogs
● https://emcrit.org/emcrit/new-fluid-assessment-sepsis/
● https://emcrit.org/emcrit/ivc-ultrasound-for-fluid-tolerance-in-spontaneously-breathing-patients/
● https://emcrit.org/emcrit/point-of-care-ultrasound-rush/
● https://emcrit.org/emcrit/emcrit-wee-advanced-ultrasound-assessment-volume-status/
● https://emcrit.org/emcrit/ivc-ultrasound/
● https://emcrit.org/emcrit/fluid-responsiveness-with-dr-paul-marik/
● https://emcrit.org/pulmcrit/abdominal-hypertension/
● https://emcrit.org/emcrit/assessing-fluid-responsiveness/
● https://rebelem.com/future-non-invasive-hemodynamic-monitoring-ready-primetime/
● https://rebelem.com/beyond-acls-pocus-in-cardiac-arrest/
● https://rebelem.com/predicting-fluid-responsiveness-passive-leg-raise-plr/
● https://rebelem.com/beyond-acls-pocus-in-cardiac-arrest/
● https://rebelem.com/reason-trial-pocus-cardiac-arrest/
● https://rebelem.com/rebel-cast-ep58-would-you-be-shoc-ed-if-pocus-did-not-improve-clinical-outcomes-in-patients-with-undifferentiated-shock/
● https://www.theresusroom.co.uk/shock/
● https://www.theresusroom.co.uk/courses/ultrasound-in-cardiac-arrest/
● https://www.thebottomline.org.uk/summaries/icm/shoc-ed-3/
● https://www.thebottomline.org.uk/summaries/icm/pocus-feissel/
