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Echocardiographic Evaluation of Shock

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POCUS in Critical Care, Anesthesia and Emergency Medicine
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Abstract

Circulatory shock is life-threatening, characterized by acute end organ hypoperfusion. Management of this condition relies on the diagnosis of the cause of the shock and the identification of the hemodynamic profile to provide optimal management. The use of echocardiography resolves the diagnostic problem in a few minutes and offers a large hemodynamic evaluation and a greater comprehension of hemodynamic disorder. Serial assessment can depict accurately uncommon acute conditions that are crucial in guiding patient management.

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References

  1. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369(18):1726–34.

    Article  CAS  PubMed  Google Scholar 

  2. Hiemstra B, Koster G, Wiersema R, Hummel YM, van der Harst P, Snieder H, et al. The diagnostic accuracy of clinical examination for estimating cardiac index in critically ill patients: the simple intensive care studies—I. Intensive Care Med. 2019;45:190–200.

    Article  PubMed  Google Scholar 

  3. Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795–815.

    Article  PubMed  PubMed Central  Google Scholar 

  4. De Backer D, Vieillard-Baron A. Clinical examination: a trigger but not a substitute for hemodynamic evaluation. Intensive Care Med. 2019;45(2):269–71.

    Article  PubMed  Google Scholar 

  5. Hussain A, Via G, Melniker L, Goffi A, Tavazzi G, Neri L, et al. Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus. Crit Care. 2020;24(1):1–18.

    Article  Google Scholar 

  6. Michard F, Malbrain ML, Martin GS, Fumeaux T, Lobo S, Gonzalez F, et al. Haemodynamic monitoring and management in COVID-19 intensive care patients: an international survey. Anaesthesia Crit Care Pain Med. 2020;39(5):563–9.

    Article  Google Scholar 

  7. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020;8(5):506–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. García-Cruz E, Manzur-Sandoval D, Gopar-Nieto R, Murillo-Ochoa AL, Bejarano-Alva G, Rojas-Velasco G, et al. Transthoracic echocardiography during prone position ventilation: lessons from the COVID-19 pandemic. J Am Coll Emerg Phys Open. 2020;1(5):730–6.

    Google Scholar 

  9. Vincent JL, Rhodes A, Perel A, Martin GS, Rocca GD, Vallet B, et al. Clinical review: update on hemodynamic monitoring-a consensus of 16. Crit Care. 2011;15(4):1–8.

    Article  Google Scholar 

  10. De Backer D, Bakker J, Cecconi M, Hajjar L, Liu DW, Lobo S, et al. Alternatives to the Swan–Ganz catheter. Intensive Care Med. 2018;44:730–41.

    Article  PubMed  Google Scholar 

  11. Vieillard-Baron A, Millington SJ, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A, et al. A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med. 2019;45:770–88.

    Article  PubMed  Google Scholar 

  12. Vieillard-Baron A, Charron C, Chergui K, Peyrouset O, Jardin F. Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient? Intensive Care Med. 2006;32:1547–52.

    Article  PubMed  Google Scholar 

  13. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–77.

    Article  PubMed  Google Scholar 

  14. McLean A. Echocardiography in management of the shocked patient. Ultrasound Med Biol. 2019;45:S12.

    Article  Google Scholar 

  15. De Backer D, Giglioli S. Echocardiographic approach to shock. J Emerg Crit Care Med. 2019;3:35–40.

    Article  Google Scholar 

  16. Huson MA, Kaminstein D, Kahn D, Belard S, Ganesh P, Kandoole-Kabwere V, et al. Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa. Ultrasound J. 2019;11(1):1–10.

    Article  Google Scholar 

  17. Mayo PH, Chew M, Douflé G, Mekontso-Dessap A, Narasimhan M, Vieillard-Baron A. Machines that save lives in the intensive care unit: the ultrasonography machine. Intensive Care Med. 2022;48(10):1429–38.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Vignon P, Merz TM, Vieillard-Baron A. Ten reasons for performing hemodynamic monitoring using transesophageal echocardiography. Intensive Care Med. 2017;43:1048–51.

    Article  PubMed  Google Scholar 

  19. Teboul JL, Saugel B, Cecconi M, De Backer D, Hofer CK, Monnet X, et al. Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med. 2016;42:1350–9.

    Article  PubMed  Google Scholar 

  20. Hlaing M, He J, Haglund N, Takayama H, Flynn BC. Impact of a monoplane hemodynamic TEE (hTEE) monitoring device on decision making in a heterogeneous hemodynamically unstable intensive care unit population: a prospective, observational study. J Cardiothorac Vasc Anesth. 2018;32(3):1308–13.

    Article  PubMed  Google Scholar 

  21. Joseph MX, Disney PJ, Da Costa R, Hutchison SJ. Transthoracic echocardiography to identify or exclude cardiac cause of shock. Chest. 2004;126:1592–7.

    Article  PubMed  Google Scholar 

  22. Micek ST, McEvoy C, McKenzie M, Hampton N, Doherty JA, Kollef MH. Fluid balance and cardiac function in septic shock as predictors of hospital mortality. Crit Care. 2013;17(5):1–9.

    Article  Google Scholar 

  23. Bouchez S, Wouters PF. Echocardiography in the intensive care unit. Curr Anesthesiol Rep. 2019;9:360–7.

    Article  Google Scholar 

  24. Boissier F, Razazi K, Seemann A, Bedet A, Thille AW, de Prost N, et al. Left ventricular systolic dysfunction during septic shock: the role of loading conditions. Intensive Care Med. 2017;43:633–42.

    Article  PubMed  Google Scholar 

  25. Van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017;136(16):e232–68.

    PubMed  Google Scholar 

  26. Daulasim A, Vieillard-Baron A, Geri G. Hemodynamic clinical phenotyping in septic shock. Curr Opin Crit Care. 2021;27(3):290–7.

    Article  PubMed  Google Scholar 

  27. Geri G, Vignon P, Aubry A, Fedou AL, Charron C, Silva S, et al. Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis. Intensive Care Med. 2019;45:657–67.

    Article  PubMed  Google Scholar 

  28. Sanfilippo F, Corredor C, Fletcher N, Tritapepe L, Lorini FL, Arcadipane A, et al. Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis. Crit Care. 2018;22(1):1–12.

    Article  Google Scholar 

  29. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur J Echocardiogr. 2016;17(12):1321–60.

    Google Scholar 

  30. Levy B, Bastien O, Bendjelid K, Cariou A, Chouihed T, Combes A, et al. Experts’ recommendations for the management of adult patients with cardiogenic shock. Ann Intensive Care. 2015;5:1–10.

    Google Scholar 

  31. Blanco P, Aguiar FM, Blaivas M. Rapid ultrasound in shock (RUSH) velocity-time integral: a proposal to expand the RUSH protocol. J Ultrasound Med. 2015;34(9):1691–700.

    Article  PubMed  Google Scholar 

  32. Mercado P, Maizel J, Beyls C, Titeca-Beauport D, Joris M, Kontar L, et al. Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient. Crit Care. 2017;21:1–8.

    Article  Google Scholar 

  33. Cholley B. Echocardiography in the intensive care unit: beyond “eyeballing”. A plea for the broader use of the aortic velocity–time integral measurement. Intensive Care Med. 2019;45(6):898–901.

    Article  PubMed  Google Scholar 

  34. Malbrain ML, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. Ann Intensive Care. 2018;8(1):1–16.

    Article  CAS  Google Scholar 

  35. Monnet X, Shi R, Teboul JL. Prediction of fluid responsiveness. What’s new? Ann Intensive Care. 2022;12(1):1–16.

    Article  Google Scholar 

  36. Pang Q, Hendrickx J, Liu HL, Poelaert J. Contemporary perioperative haemodynamic monitoring. Anaesthesiol Intensive Ther. 2019;51(2):147–58.

    Article  PubMed  Google Scholar 

  37. Muller L, Toumi M, Bousquet PJ, Riu-Poulenc B, Louart G, Candela D, et al. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study. J Am Soc Anesthesiol. 2011;115(3):541–7.

    Article  CAS  Google Scholar 

  38. Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung ultrasound for critically ill patients. Am J Respir Crit Care Med. 2019;199(6):701–14.

    Article  PubMed  Google Scholar 

  39. Lambden S, Creagh-Brown BC, Hunt J, Summers C, Forni LG. Definitions and pathophysiology of vasoplegic shock. Crit Care. 2018;22(1):1–8.

    Article  Google Scholar 

  40. Hochman JS. Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation. 2003;107(24):2998–3002.

    Article  PubMed  Google Scholar 

  41. Mohebi R, Liu Y, van Kimmenade R, Gaggin HK, Murphy SP, Januzzi JL Jr. Inflammation across universal definition of heart failure stages: the CASABLANCA study. Eur J Heart Fail. 2023;25(2):152–60.

    Article  CAS  PubMed  Google Scholar 

  42. Squiccimarro E, Labriola C, Malvindi PG, Margari V, Guida P, Visicchio G, et al. Prevalence and clinical impact of systemic inflammatory reaction after cardiac surgery. J Cardiothorac Vasc Anesth. 2019;33(6):1682–90.

    Article  PubMed  Google Scholar 

  43. Vieillard-Baron A, Slama M, Mayo P, Charron C, Amiel JB, Esterez C, et al. A pilot study on safety and clinical utility of a single-use 72-hour indwelling transesophageal echocardiography probe. Intensive Care Med. 2013;39:629–35.

    Article  PubMed  Google Scholar 

  44. Alsaddique A, Royse AG, Royse CF, Mobeirek A, El Shaer F, AlBackr H, et al. Repeated monitoring with transthoracic echocardiography and lung ultrasound after cardiac surgery: feasibility and impact on diagnosis. J Cardiothorac Vasc Anesth. 2016;30(2):406–12.

    Article  PubMed  Google Scholar 

  45. Merz TM, Cioccari L, Frey PM, Bloch A, Berger D, Zante B, et al. Continual hemodynamic monitoring with a single-use transesophageal echocardiography probe in critically ill patients with shock: a randomized controlled clinical trial. Intensive Care Med. 2019;45:1093–102.

    Article  CAS  PubMed  Google Scholar 

  46. Chinen D, Fujino M, Anzai T, Kitakaze M, Goto Y, Ishihara M, et al. Left ventricular outflow tract velocity time integral correlates with low cardiac output syndrome in patients with acute decompensated heart failure. Eur Heart J. 2013;34(suppl_1):4249.

    Article  Google Scholar 

  47. Bouchez S, Van Belleghem Y, De Somer F, De Pauw M, Stroobandt R, Wouters P. Haemodynamic management of patients with left ventricular assist devices using echocardiography: the essentials. Eur Heart J Cardiovasc Imaging. 2019;20(4):373–82.

    Article  PubMed  Google Scholar 

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Hemamid, H. (2024). Echocardiographic Evaluation of Shock. In: Bouarroudj, N., Cano, P.C., Fathil, S.b.M., Hemamid, H. (eds) POCUS in Critical Care, Anesthesia and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-43721-2_16

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  • DOI: https://doi.org/10.1007/978-3-031-43721-2_16

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  • Online ISBN: 978-3-031-43721-2

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