Transthoracic echocardiography for evaluation of hypotensive critically ill patient.

Paulo Marcelino, Susan Marum, Ana Paula Fernandes, Mário G Lopes

Abstract


a prospective study to determine the value of transthoracic echocardiography (TTE) in assessing hypotensive patients in a medical/surgical Intensive care Unit (ICU).a 16-bed medical/surgical ICU.patients with hypotension were studied (systolic arterial pressure < 90 mmHg or mean arterial pressure < 60 mmHg, non responsive to fluid therapy in a 30-minute period). TTE was aimed to: exclude severe cardiac dysfunction(abnormalities requiring immediate therapeutic decision); to evaluate other non severe cardiac alterations; to determine cardiac index (CI) and analyse inferior vena cava (IVC).Two hundred eight patients were studied, and 198 enrolled (4.5% of impossible examinations), with a mean age 63.4 +/- 16.2 years, 129 male, APACHE II score 30.1 +/- 9.9, SAPS II 68.8 +/- 20.5, SOFA 11.6 +/- 3.8, MODS 10.9 +/- 3.9. Mortality was 51% (n=101) and 168 (82.2%) patients were under mechanical ventilation. Forty four patients (44.4%) presented cardiac abnormalities, 28 of whom (14%) severe cardiac diseases. Of these, 18 (9%) presented unsuspected situations (aortic stenosis, 3; endocarditis, 4, dilated miocardiopathy, 9, cardiac tamponade, 2). Patients with cardiac abnormalities were older and presented higher severity scores and mortality. Most patients (158, 79.7%) presented a normal/high IC, all with low peripheral vascular resistance. Through logistic regression analysis, a statistically significant between IVC index and ICU stay (p=0.05); IC and IVC index correlated with overall mortality (p=0,008 and 0,041 respectively).Patients with hypotension in a medical/surgical ICU presented a high rate of cardiac abnormalities (44.4%, n=88), including 26 patients with severe diseases, requiring immediate therapeutic decisions. IC and IVC analysis may be useful to determine hemodynamic profile and several TTE parameters may have prognostic value.

Full Text:

PDF (Português)


Refbacks

  • There are currently no refbacks.