Bedside thoracic echography in ICU: new insights for acute circulatory and respiratory failure

In intensive care, hemodynamic and respiratory failure are the two main types of organ failure and are frequently associated. In cases of shock and/or acute dyspnea, thoracic ultrasound involves the simultaneous use of lung ultrasound and transthoracic echocardiography. While rigorous clinical assessment remains fundamental, the current literature shows that adding thoracic ultrasound to conventional examination improves diagnostic accuracy and enables rapid, adequate therapeutic decisions during shock and/or acute respiratory failure in a non-invasive way. However, its impact on survival is still being debated. This narrative review summarizes the criteria that help identify the five main hemodynamic profiles during shock, as well as the endpoints that allow discrimination between cardiogenic pulmonary edema, acute respiratory distress syndrome, pneumonia, pleural effusion and pneumothorax. It also proposes pragmatic algorithms for managing shock and/or respiratory failure at the bedside. Current data suggest that artificial intelligence and automated measurements will greatly improve the diagnostic performance, reproducibility, ease of use, and teachability of thoracic ultrasound in the near future.