Critical Care |

Classification of Shock Based on Functional Hemodynamic Parameters and Bedside Ultrasound Findings FREE TO VIEW

Ramakant Sharma, MBBS; William McGee, MD; Adam Adler, MD
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Baystate Medical Center, Springfield, MA

Chest. 2014;145(3_MeetingAbstracts):177A. doi:10.1378/chest.1833527
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SESSION TITLE: Critical Care Posters II

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Standard textbooks still report conventional classification charts for the shock states. New modalities such as stroke volume variability and pulse pressure variability in addition to the widespread availability and use of ultrasound in modern intensive care units should be included in the schematics for shock management.

METHODS: Current editions of standard textbooks were reviewed for incorporation of dynamic measures of volume responsiveness along with ultrasound based approach into the classification scheme for various shock states. We present an updated scheme for the conceptual classification of shock states based on current measures of volume responsiveness (PPV and SVV) and on stroke volume along with ultrasound findings which add or confirm the diagnosis.

RESULTS: The results have been prepared in a tabular form (not place able here). We identify the following parameters for the shock states of hypovolemic, cardiogenic, septic, obstructive: Cardiac output/Stoke volume, Systemic Vascular resistance, Conventional preload measures (CVP/PAOP), Stroke volume variation or pulse pressure variation (SVV/PPV). Included in the results table, we characterized the shock states according to the rapid ultrasound in shock (RUSH) protocol with subcategories including: pump, tank, pipes for the four shock states in both early and late phases of shock.

CONCLUSIONS: Newer variables classifying shock are not included in standard textbooks. We propose the new classification scheme utilizing bedside ultrasound and functional hemodynamic variables (Table1).

CLINICAL IMPLICATIONS: The use of newer modalities such as stroke volume variability and pulse pressure variability as well as bedside ultrasound are invaluable tools for the assessment of critical care. As these assessment tools have become mainstream, we feel that they should be added to standard tables characterizing shock states.

DISCLOSURE: The following authors have nothing to disclose: Ramakant sharma, William McGee, Adam Adler

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