Optimizing the use of critical care echocardiography: from point-of-care tool to monitoring modality.

PURPOSE OF REVIEW: To summarize latest evidence on the use of critical care echocardiography for haemodynamic management of the critically ill patient. RECENT FINDINGS: Echocardiography is now considered a cornerstone for hemodynamic management and is recommended by recent guidelines. Its ability to quickly assess undifferentiated shock helps clinicians in diagnosis and immediate management. In stabilizing and optimizing treatment of the shocked patient, serial echocardiography guides fluid, vasopressor, and inotrope therapy while allowing detailed assessment of cardiac structure and function. Echocardiography may be used to assess fluid-responsiveness and myocardial function, conversely, echocardiography and ultrasonography can identify patients who are at risk of harm induced by fluid overload, mechanical ventilation and inotropes, allowing further refinement of therapeutic strategies. When continuous cardiac output monitoring or advanced haemodynamic data are required, echocardiography should be complemented with continuous haemodynamic monitoring rather than used alone. SUMMARY: We provide a framework for the optimal use of critical care echocardiography, from a point-of-care tool to a sophisticated hemodynamic monitor.