From Probe to Scope: Bedside Echocardiography in the Assessment of Shockv A Focused State-of-the-Art Narrative Review of Multimodal Point-of-Care Ultrasound for Haemodynamic Phenotyping, Physiology-Guided Therapy and Serial Reassessment

Abstract

Circulatory shock is an acute, life threatening state of tissue hypoperfusion caused by hypovolemic, cardiogenic, obstructive, or distributive which requiring different treatment. Guidelines now recommended echocardiography as the first line diagnostic tool. This review aimed to synthesize evidence on point of care ultrasound (POCUS), combining cardiac, lung, venous, and abdominal imaging for phenotyping shock and guiding bedside hemodynamics management. A focused narrative review searched in the MEDLINE/PubMed, Semantic Scholar, Scopus and preprint repositories. Keywords used were shock physiology, cardiac ultrasound, fluid responsiveness and tolerance, and right ventricular assessment. Pooled analysis from 1,132 patients demonstrated POCUS identifies shock etiology with 0.78 to 0.90 sensitivity and 0.92 to 0.98 specificity. LVOT velocity time integral served as a stroke volume surrogate and 10 percent rise after passive leg raising predicted fluid responsiveness (AUC 0.91 to 0.95). Lung ultrasound, inferior vena cava assessment, and the VExUS score identified fluid tolerance, while right ventricular size and TAPSE/PASP ratio identified high mortality phenotypes. In conclusion, bedside echocardiography should function as a repeated physiological test answering the shock phenotype, flow status, and fluid tolerance.