Purpose: This systematic review aimed to assess the accuracy of ultrasound in diagnosing shock types among intensive care patients. Materials and methods: A comprehensive search of PubMed, Embase, Scopus, Cochrane Central Register, and Google Scholar was conducted for controlled trials published up to June 2023. Two intensivists independently screened articles for full-text reviews and abstracts, evaluating study quality using the QUADAS-2 tool. Prospective studies assessing ultrasound for diagnosing shock types in critically ill patients with undifferentiated shock were included. Results: Among 7287 articles identified, four met the inclusion criteria for meta-analysis. Pooled positive likelihood ratios were 8.8 (95% CI: 2.4–32.37) for distributive shock and 137.56 (95% CI: 27.76–681.64) for obstructive shock. Summary receiver operating characteristic (SROC) curves showed an area under the curve (AUC) of 0.99 for cardiogenic and obstructive shock, 0.5 for hypovolemic and mixed shock, and 0.76 for distributive shock. Pooled negative likelihood ratios ranged from 0.05 (95% CI: 0.010 to 0.24) for cardiogenic shock to 0.22 (95% CI: 0.127–0.38) for mixed-etiology shock. Conclusion: Ultrasound demonstrates high accuracy in diagnosing obstructive and cardiogenic shock among intensive care patients with undifferentiated shock. However, its utility for other shock types appears limited.