Clinical role of critical care echocardiography in septic patients: Current knowledge and future directions

Critical care echocardiography (CCE) use is rapidly growing and echocardiography is recommended as first-line approach to patients presenting with shock. In most cases the prompt use of CCE offers the opportunity to quickly identify the shock aetiology, with the advantage of being a non-invasive point-of-care tool. Septic shock is among the most common diagnoses of hypotension both in the emergency department and in the intensive care unit. CCE may have a substantial role in sepsis. Initially it may exclude other causes of hypotension and support the appropriateness of fluid-resuscitation. After the initial resuscitation, CCE may help in directing fluid management, guiding the “optimization” and “stabilization” phases, identifying among others conditions of fluidresponsiveness. In a later stage, CCE can be likewise helpful for the “de-escalation” phase of fluid management, supporting a goal-directed fluid removal. We summarize the current knowledge on the use of CCE in sepsis from the gap in knowledge with opened questions for future research to the use of CCE from clinical perspectives in guiding fluid and pharmacological therapy.