European Society of Intensive Care Medicine (ESICM) guidelines on circulatory shock and hemodynamic monitoring 2025

Monitor skin perfusion by capillary refill time, may be complemented by skin temperature and mottling

With a central venous catheter, perform serial measurements of (central) venous oxygen saturation and veno-arterial difference in carbon dioxide partial pressure

In persistent shock after initial fluid resuscitation, assess fluid responsiveness before continuing fluid resuscitation

Recommended: dynamic variables over static markers of preload for predicting fluid responsiveness, when applicable

Monitor cardiac output (CO) and/or stroke volume in patients not responding to initial therapy

Monitor arterial pressure with an arterial catheter in shock not responsive to initial therapy and/or requiring vasopressor infusion

Measure central venous pressure in patients with a central venous catheter

Suggested: echocardiography as first-line imaging modality to assess the type of shock

Echocardiographically defined phenotypes of left and right ventricular dysfunction may be of prognostic significance