Maurizio Cusmà Piccione, Luigi Colarusso, Eustachio Agricola, Matteo Cameli, Antonio De Luca, Roberta Manganaro, Agata Barchitta, Antonello D’Andrea, Vito Maurizio Parato, Paolo Trambaiolo, Concetta Zito, Pio Caso, Giovanni Di Salvo, This Document was promoted by Members of the 2024-2025 SIECVI Scientific Documents Committee and Reviewed by Ilaria Caso and Giovanni Di Salvo
University of Messina. IRCCS San Raffaele Scientific Institute. University of Siena. Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste. Padova University Hospital. Umberto I Hospital. Madonna del Soccorso Hospita. Sandro Pertini Hospital. “V. Monaldi” Hospital. University of Padua.
Italy
Journal of Cardiovascular Echography
J Cardiovasc Echogr 2025; 35: 79-90
DOI: 10.4103/jcecho.jcecho_15_25
Abstract
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.
Category
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Review Articles Concerning Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease or Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes