POCUS shock management: point-of-care ultrasound in the integrated management of shock

Shock is a critical syndrome with high mortality, with multiple causes and with diversified pathophysiology. The possibility of influencing the prognosis directly depends on the timeliness and correctness of the diagnosis, in its three components: status diagnosis, etiological diagnosis and physio-pathological diagnosis; it is also necessary to continuously monitor, especially in the early hours, the response to therapeutic interventions, to confirm, to integrate or to stop the treatments started, in particular fluids and cardio-vasoactive agents. The state diagnosis is based on the vital parameters and the dosage of lactates; the etiology is defined thanks to clinical evaluation (history and physical examination) and diagnostic imaging; cardiovascular physopathology can be demonstrated with instrumental tests that can evaluate the functional dynamic components. For monitoring and guidance of therapy it is essential to integrate the detection of clinical and biohumoral data with the continuous or repeated evaluation of haemodynamic variables. Multiple district point-of-care ultrasound (POCUS) has acquired a central role in shock management, for etiological and physiopathological diagnosis, for support of invasive procedures, and for monitoring and therapy guidance. POCUS allows to evaluate all the relevant aspects of cardiovascular pathophysiology: volume status and preload, biventricular systolic function, stroke volume, left ventricular diastolic function, pulmonary extravascular fluid, peripheral venous system filling status. POCUS has some decisive advantages over other methods: timeliness, accuracy, repeatability, non-invasiveness, safety for patients, low costs. The integration of multiple district POCUS with clinical (capillary refill time) and biohumoral (lactate) evaluation, which verifies the effects of therapy on perfusion and organ function, allows a simplified and accurate management of patients in shock, with positive impact on health outcomes.