Evaluation and management of shock.

Shock is one of the most frequent situations encountered in the intensive care unit (ICU). Important new concepts have emerged for shock management in recent years. The concept of early goal-directed therapy has evolved from the basic management concepts for septic shock delivered in a structured fashion. Numerous cardiovascular techniques, methods, and strategies have been developed as novel alternatives to the use of the pulmonary artery catheter. Among these techniques, echocardiography, esophageal Doppler, and arterial pulse contour analysis show great promise. Prediction of responsiveness to fluid administration is a key component of the management of shock, as is assessing cardiovascular performance. The intensive care physician has several options to evaluate and treat shock. Further research should yield additional important advances.