How to Do Echo for Noninvasive Hemodynamic Evaluation of the Patient in the Intensive Care Unit: A Consensus Statement of the Italian Society of Echocardiography and Cardiovascular Imaging

Critically ill patients in the intensive care unit (ICU) require continuous hemodynamic monitoring to guide therapeutic decisions and prevent clinical deterioration. Echocardiography has emerged as a cornerstone for noninvasive hemodynamic assessment, offering real-time, bedside evaluation of key parameters such as venous congestion, pulmonary pressures, left atrial pressure (LAP), systemic vascular resistances, cardiac output, and ventricular-arterial coupling. Systemic venous congestion and right atrial pressure (RAP) can be assessed through inferior vena cava diameter measurement and respiratory variation, with additional accuracy provided by the VeXUS score, which incorporates hepatic, portal, and renal vein Doppler profiles. Internal jugular vein assessment and left ventricular (LV) stroke volume variability further refine RAP estimation. Pulmonary hypertension (PH) and right ventricular dysfunction can be evaluated through echocardiographic markers that differentiate precapillary from postcapillary PH, enabling tailored treatment strategies. In addition, echocardiography is fundamental for detecting right ventricular failure, particularly in PH and cardiogenic shock. LAP and systemic hemodynamics are integral to assessing LV diastolic and systolic dysfunction, which are pivotal in heart failure and cardiogenic shock management. Echocardiography also provides insights into vascular system properties and their interaction with cardiac performance, while lung ultrasound aids in detecting interstitial edema of cardiac origin. As a fast, reliable, and reproducible tool, echocardiography is the gold standard for noninvasive hemodynamic assessment in ICU patients, facilitating prompt and precise therapeutic decisions.