- Echo Education
- Open Access
- Published:
Critical Care Echo Rounds
Haemodynamic instability
Echo Research & Practice volume 1, pages D1–D8 (2014)
Abstract
The use of echocardiography, whilst well established in cardiology, is a relatively new concept in critical care medicine. However, in recent years echocardiography’s potential as both a diagnostic tool and a form of advanced monitoring in the critically ill patient has been increasingly recognised. In this series of Critical Care Echo Rounds, we explore the role of echocardiography in critical illness, beginning here with haemodynamic instability. We discuss the pathophysiology of the shock state, the techniques available to manage haemodynamic compromise, and the unique role which echocardiography plays in this complex process.
Case
A 69-year-old female presents to the emergency department with a fever, confusion and pain on urinating. Her blood pressure on arrival was 70/40, with heart rate of 117-bpm Despite 3-l of i.v. fluid she remained hypotensive. A central venous catheter was inserted and noradrenaline infusion commenced, and she was admitted to the intensive care unit for management of her shock state. At 6-h post admission, she was on high dose of noradrenaline (0.7-μg/kg per min) but blood pressure remained problematic. An echocardiogram was requested to better determine her haemodynamic state.
References
Graham CA & Parke TRJ 2005 Critical care in the emergency department: shock and circulatory support. Emergency Medicine Journal 22 17–21. doi:10.1136/emj.2003.012450
Clarke J 1743 A treatise, or reflections drawn from practice on gun-shot wounds. John Clarke: London, UK. Trans. of HF Le Dran 1737 Traité ou reflexions tirées de la pratique sur les playes d’armes à feu. Charles Osmont: Paris, France.
Ristic´ AD, Imazio M, Adler Y, Anastasakis A, Badano LP, Brucato A, Caforio AL, Dubourg O, Elliott P & Gimeno J Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases European Heart Journal 2014 [in press] doi:10.1093/eurheartj/ehu217
Mars T, Mikolavcic H, Salobir B & Podbregar M 2010 Echocardiography of isolated subacute left heart tamponade in a patient with cor pulmonale and circumferential pericardial effusion. Cardiovascular Ultrasound 14 8–27. doi:10.1186/1476-7120-8-27
Price LC, Wort SJ, Finney SJ, Marino PS & Brett SJ 2010 Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review. Critical Care 14 R169 doi:10.1186/cc9264
Vieillard-Baron A, Schmitt JM, Roch Augarde R, Fellahi JL, Prin S, Page B, Beauchet A & Jardin F 2001 Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. Critical Care Medicine 29 1551–1555. doi:10.1097/00003246-200108000-00009
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK & Schiller NB 2010 Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Journal of the American Society of Echocardiography 23 685–713. doi:10.1016/j.echo.2010.05.010
Milan A, Magnino C & Veglio F 2010 Echocardiographic indexes for the non-invasive evaluation of pulmonary hemodynamics. Journal of the American Society of Echocardiography 23 225–239. doi:10.1016/j.echo.2010.01.003
Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA & Lester SJ 2003 A simple method for noninvasive estimation of pulmonary vascular resistance. Journal of the American College of Cardiology 41 1021–1027. doi:10.1016/S0735-1097(02)02973-X
Scapellato F, Temporelli PL, Eleuteri E, Corrà U, Imparato A & Giannuzzi P 2001 Accurate noninvasive estimation of pulmonary vascular resistance by Doppler echocardiography in patients with chronic failure heart failure. Journal of the American College of Cardiology 37 1813–1819. doi:10.1016/S0735-1097(01)01271-2
Haddad F, Zamanian R, Beraud AS, Schnittger I, Feinstein J, Peterson T, Yang P, Doyle R & Rosenthal D 2009 A novel non-invasive method of estimating pulmonary vascular resistance in patients with pulmonary arterial hypertension. Journal of the American Society of Echocardiography 22 523–529. doi:10.1016/j.echo.2009.01.021
Brown JM, Murtha W, Fraser J & Khoury V 2002 Dynamic left ventricular outflow tract obstruction in critically ill patients. Critical Care and Resuscitation 4 170–172.
Panduranga P, Maddali MM, Mukhaini MK & Valliattu J 2010 Dynamic left ventricular outflow tract obstruction–complicating aortic valve replacement: a hidden malefactor revisited. Saudi Journal of Anaesthesia 4 99–101. doi:10.4103/1658-354X.65118
Chockalingam A, Tejwani L, Aggarwal K & Dellsperger KC 2007 Dynamic left ventricular outflow tract obstruction in acute myocardial infarction with shock: cause, effect, and coincidence. Circulation 116 e110–e113. doi:10.1161/CIRCULATIONAHA.107.711697
Michard F & Teboul JL 2002 Predicting fluid responsiveness in ICU patients. A critical analysis of the evidence. Chest 121 2000–2008. doi:10.1378/chest.121.6.2000
Mandeville JC & Colebourn CL 2012 Can transthoracic echocardiography be used to predict fluid responsiveness in the critically ill patient? A systematic review. Critical Care Research and Practice 2012 Article ID 513480 doi:10.1155/2012/513480
Berkenstadt H, Margalit N, Hadani M, Friedman Z, Segal E, Villa Y & Perel A 2001 Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesthesia and Analgesia 92 984–989. doi:10.1097/00000539-200104000-00034
Feissel M, Michard F, Mangin I, Ruyer O, Faller JP & Teboul JL 2001 Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119 867–873. doi:10.1378/chest.119.3.867
Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, Quintard H, Leone M, Zoric L, Lefrant JY et al 2012 Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Critical Care 16 R188 http://ccforum.com/content/16/5/R188 doi:10.1186/cc11672
Feissel M, Michard F, Faller JP & Teboul JL 2004 The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Medicine 30 1834–1837. doi:10.1007/s00134-004-2233-5
Monnet X & Teboul JL 2013 Assessment of volume responsiveness during mechanical ventilation: recent advances. Critical Care 17 217 doi:10.1186/cc12526
Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR & Teboul JL 2006 Passive leg raising predicts fluid responsiveness in the critically ill. Critical Care Medicine 34 1402–1407. doi:10.1097/01.CCM.0000215453.11735.06
Marik PE, Monnet X & Teboul JL 2011 Hemodynamic parameters to guide fluid therapy. Annals of Intensive Care 1 1 doi:10.1186/2110-5820-1-1
Repessé X, Charron C & Vieillard-Baron A 2013 Evaluation of left ventricular systolic function revisited in septic shock. Critical Care 17 164 doi:10.1186/cc12755
Akashi YJ, Goldstein DS, Barbaro G & Ueyama T 2008 Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation 118 2754–2762. doi:10.1161/CIRCULATIONAHA.108.767012
Author information
Authors and Affiliations
Corresponding author
Additional information
PGDip in Perioperative and Critical Care Echocardiography
Rights and permissions
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://doi.org/creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
About this article
Cite this article
Roshdy, A., Francisco, N., Rendon, A. et al. Critical Care Echo Rounds. Echo Res Pract 1, D1–D8 (2014). https://doi.org/10.1530/ERP-14-0008
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1530/ERP-14-0008