The Refresher Course in Haemodynamics

Haemodynamics Pathway Directors:

Michelle CHEW MD, PhD Professor Anaesthesia and Intensive Care Medicine, Linköping University Hospital, Linköping, Sweden; Chair Cardiovascular Dynamics Section, ESICM

Antonio MESSINA MD, PhD ICU senior consultant, Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center – IRCCS, Rozzano (Milano), Italy; Chair Cardiovascular Dynamics Section, ESICM

Xavier MONNET MD, PhD, Professor of Intensive Care, Medical Intensive Care Unit, Bicêtre Hospital, Paris-Saclay University Hospitals, Paris, France; Chair Cardiovascular Dynamics Section, ESICM

Course Directors Refresher:

• Michelle CHEW MD, PhD Professor Anaesthesia and Intensive Care Medicine, Linköping University Hospital, Linköping, Sweden; Chair Cardiovascular Dynamics Section, ESICM
• Antonio MESSINA MD, PhD ICU senior consultant, Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center – IRCCS, Rozzano (Milano), Italy; Chair Cardiovascular Dynamics Section, ESICM
• Xavier MONNET MD, PhD, Professor of Intensive Care, Medical Intensive Care Unit, Bicêtre Hospital, Paris-Saclay University Hospitals, Paris, France; Chair Cardiovascular Dynamics Section, ESICM

Endorsement: The Course is endorsed by the Cardiovascular Dynamics Section, ESICM.

• Explain and apply therapeutic strategies for different types of shock, including:
  • Septic shockCardiogenic shockObstructive shockAnaphylactic shock
• Discuss and manage mechanical ventilation weaning failure of cardiac origin.
• Assess fluid responsiveness using both static and dynamic tests, including the application of a fluid challenge.
• Select and justify appropriate haemodynamic monitoring methods in the ICU setting based on patient condition.
• Interpret indicators of oxygen delivery and tissue oxygenation, including:
  • Mixed venous oxygen saturation (SvO₂)
  • Veno-arterial CO₂ gap (vaCO₂ gap)
  • Advanced monitoring technologies (e.g., sublingual microscopy)
• Evaluate and apply point-of-care ultrasound (POCUS) for:
• Diagnosis of shock
• Monitoring and ongoing management
• Integration with clinical and haemodynamic data
• Assess the role and limitations of advanced invasive haemodynamic monitoring, including:
  • Indications for use
  • Integration with clinical findings and ultrasound
• Appraise and choose appropriate haemodynamic monitoring strategies during the resuscitation phase of shock.
• Discuss the appropriate use of vasopressors and inotropes according to the underlying cause of shock.
• Describe the principles of advanced haemodynamic monitoring, including transpulmonary thermodilution technology.
• Compare advantages and disadvantages of various haemodynamic assessment methods.
• Recognize clinical, laboratory, and imaging findings of shock, including:
  • ECG changes
  • Chest radiograph findings
  • Point-of-care laboratory results
  • Basic echocardiographic features
• Determine appropriate early therapeutic interventions in patients presenting with shock.

• Cardiac–arterial coupling: interpretation in clinical practice
• Lactate and capillary refill time (CRT): interpretation
• ScvO₂ and v-a CO₂ gap: interpretation
• Assessment of fluid responsiveness at the bedside using hemodynamic tools
• Functional hemodynamic tests (selection and interpretation)
• Administration of a fluid bolus
• Transpulmonary thermodilution: use and interpretation
• Swan-Ganz catheter: use and interpretation
• Critical care echocardiography: use and interpretation
• Use of vasopressors in shock
• Use of inotropes in shock
• Cardiogenic shock (clinical case discussions)
• Assessment and treatment of right ventricular (RV) dysfunction
• Assessment and management of weaning failure from mechanical ventilation due to cardiac causes
• ROSE concept: bedside clinical decision-making based on physiology and monitoring methods
• Clinical scenarios with small-group discussion

• Intensivists who have completed Level 1 and Level 2
• Intensivists seeking a thorough approach in Haemodynamics
• Senior intensivists wanting a comprehensive review course on the topic

An application has been made to the UEMS EACCME® for CME accreditation of this event.