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Abstract: Slide Presentations |

CLINICAL IMPACT OF EARLY GOAL-DIRECTED ECHOCARDIOGRAPHY IN SHOCK PATIENTS PERFORMED BY NON-CARDIOLOGIST INTENSIVISTS FREE TO VIEW

Anthony Manasia, MD*; Dragos Cucu, MD; John Oropello, MD; Rosanna DelGiudice, RN; Jerry Hufanda, RN; Ernest Benjamin, MD
Author and Funding Information

Mount Sinai School of Medicine, New York, NY


Chest


Chest. 2005;128(4_MeetingAbstracts):222S. doi:10.1378/chest.128.4_MeetingAbstracts.222S
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Abstract

PURPOSE:  Circulatory shock is life-threatening requiring immediate therapeutic intervention. Real time assessment of cardiac function and volume provides information to guide fluid and vasopressor therapy. Early bedside transthoracic or transesophageal echocardiography performed by non-cardiologist intensivists has the potential to improve the management of patients with acute hemodynamic instability.* The purpose of this study is to determine the clinical impact of limited, goal-directed bedside echocardiography performed by non-cardiologist intensivists in ICU patients in shock.

METHODS:  Eighteen (n=18) patients in shock admitted to the surgical and neurosurgical ICUs were enrolled after informed written consent was obtained. Shock was defined as hypotension (MAP<65 mmHg, or SBP<90 mmHg) or need of vasopressor therapy, associated with either hyperlactatemia, oliguria/anuria or an increase in serum creatinine. A treatment plan was instituted by the ICU team. Each patient then underwent a limited echocardiographic exam (transthoracic or transesophageal), to assess left ventricular function and to estimate cardiovascular volume status (preload). The echocardiographic exam was performed by an echo-trained intensivist not involved in the patient’s care. A second echo exam was performed 24 hours later. Changes in medical management were recorded following each echo. Data were analyzed and presented in proportions using descriptive statistics.

RESULTS:  The first echo changed the treatment plan in 38.8% (7/18) of the patients when compared to the initial management instituted by the primary ICU team. The treatment plan was changed in 11.7% (2/17) of patients following the second echo exam. The mean time from enrolling patients into the study to performing the first echo was 5.1±4.1 hours.

CONCLUSION:  In evaluating patients in shock, an early limited, goal-directed echocardiographic exam performed by trained intensivists, provides new information and significantly changes medical management.

CLINICAL IMPLICATIONS:  The performance of an early, limited, goal-directed echocardiographic exam by non-cardiologist intensivists, has the potential to improve the hemodynamic management of patients in shock.*J Cardiothoracic Vasc Anesth 12 (1) 10-15, 1998.

DISCLOSURE:  Anthony Manasia, None.

10:30 AM - 12:00 PM


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