Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024.

Summary

This focused update synthesizes new evidence since 2016 and suggests using CCUS to guide management in septic shock, acute dyspnea/respiratory failure, and cardiogenic shock. Importantly, CCUS-guided targeted volume management is associated with improved mortality compared with usual care; evidence remains insufficient for cardiac arrest management.

Key Findings

• CCUS is suggested to guide management in septic shock, acute dyspnea/respiratory failure, and cardiogenic shock.
• Targeted volume management using CCUS is associated with improved mortality compared with usual care.
• Insufficient evidence to recommend CCUS over standard care for cardiac arrest management.

Clinical Implications

Embed CCUS into protocols for shock states to guide fluid responsiveness and hemodynamic decisions; prioritize training and quality assurance in CCUS. Avoid overgeneralizing to cardiac arrest pending further evidence.

Limitations

• Focused on five PICO applications; breadth may omit other CCUS uses
• Heterogeneity and limited randomized evidence in some domains (e.g., cardiac arrest)

Future Directions

Conduct multicenter RCTs on CCUS-driven protocols targeting hard outcomes; implementation science on training, credentialing, and quality control; evaluate cardiac arrest pathways.