Anestéziológia a intenzívna medicína 1/2022

Echocardiographic examination in hemodynamic unstable patients

Hypotension is almost always a symptom of hemodynamic instability and frequently develops in critically ill patients. Common causes of hypotension in ICU patients include left ventricular dysfunction due to myocardial infarction and heart failure due to different causes, such as hypovolemia, sepsis and septic shock, pulmonary embolism, cardiac tamponade and severe left-sided valvular regurgitation and stenosis. All these patients may benefit from echocardiographic evaluation. Transthoracic (TTE) and transesophageal echocardiography (TEE) have a high level of appropriateness in the diagnosis and management of hemodynamic unstable patients. In fact, in skilled hands, it needs only a few minutes to resolve a diagnostic question and guide the following therapy. We can define the major factors that determine hypotension-preload, contractility, afterload, relationship between ventricles and between the heart and lungs. Moreover, echocardiography can identify causes of hypotension that are not clinically suspected such as LV outflow tract obstruction. In this review, I would like to describe the utility of echocardiography in detecting the common causes of hypotension in Emergency department and ICU.

Keywords: hemodynamic instability, transthoracic and transesophageal echocardiography