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.
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.
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.
In evaluating patients in shock, an early limited, goal-directed echocardiographic exam performed by trained intensivists, provides new information and significantly changes medical management.
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.
Anthony Manasia, None.