PURPOSE: To define the role of Hand Carreied Ultrasound(HCU) in decision making regarding the use of volume or pressors/inotropics for hypotensive patients.
METHODS: Prospective study using HCU(OptiGo, Phillips Medical Systems). Examination performed by intensivist trained in doing echocardiography. Hypotension defined as systolic blood pressure less than 90 mmHg or 30 mmHg below the patient baseline. 2 D echo and color Doppler studies were performed. No M mode or spectral Doppler was done. Standard views were obtained, parasternal long axis , parasternal short axis , apical four and two chambers views and subcostal views. The followings were recorded: left ventricular (LV) ejection fraction ( EF) , regional wall motion ( RWM) abnormality, whether LV hyperdynamic or not, right ventricle ( RV) size, interventricular septum ( IVS) movement, inferior vena cava (IVC) size and variation with breathing, pericardial effusion and regurigtant valves by color Doppler.
RESULTS: Fifteen patients were studied. Seven females and 8 were males. Age 59.9 year.The images were adequate to make a decision in 12 patients (80%), and technically difficult in 3 patients (20%). Seven patients showed features of hypovolemia, hyperdynamic LV, IVC collapses with inspiration. Five patients ( 33.3%) has cardiac cause of hypotension, 2 patients had cardiomyopathy, one patient had massive pulmonary embolism, one patient showed RV volume overload w ith dilated RV and IVS flattening during diastole and one patient had infective endocarditis.
CONCLUSION: Hand Carried ultrasound in the ICU helps in decision making whether to use volume or pressors/inotropics and identified a cardiac cause of hypotension.
CLINICAL IMPLICATIONS: Hand Carried Ultrasound, if used appropriately, may cut down the number of invasive procedures in the ICU for hemodynamic monitoring.
DISCLOSURE: Abbas Ali, No Financial Disclosure Information; No Product/Research Disclosure Information