CRITICAL CARE ECHO ROUNDS: Haemodynamic instability

Roshdy, Ashraf; Francisco, Nadia; Rendon, A.; Gillon, Stuart; Walker, D.

doi:10.1530/erp-14-0008

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…This helps to couple better blood oxygenation with adequate delivery by the cardiovascular system. 76,77 Ultrasound is not recommended as a standalone tool but is particularly useful when considered along with clinical examination and other monitors.…”

Section: Advanced Monitoringmentioning

confidence: 99%

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

Roshdy

2023

J Intensive Care Med

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The increased application of mechanical ventilation, the recognition of its harms and the interest in individualization raised the need for an effective monitoring. An increasing number of monitoring tools and modalities were introduced over the past 2 decades with growing insight into asynchrony, lung and chest wall mechanics, respiratory effort and drive. They should be used in a complementary rather than a standalone way. A sound strategy can guide a reduction in adverse effects like ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, patient-ventilator asynchrony and helps early weaning from the ventilator. However, the diversity, complexity, lack of expertise, and associated cost make formulating the appropriate monitoring strategy a challenge for clinicians. Most often, a big amount of data is fed to the clinicians making interpretation difficult. Therefore, it is fundamental for intensivists to be aware of the principle, advantages, and limits of each tool. This analytic review includes a simplified narrative of the commonly used basic and advanced respiratory monitors along with their limits and future prospective.

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Section: Advanced Monitoringmentioning

confidence: 99%

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

Roshdy

2023

J Intensive Care Med

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“…The prediction of fluid responsiveness requires the use of dynamic indices based on heart–lung interactions, which are difficult or impossible to obtain in the cardiac arrest setting. These have been discussed in detail in a previous ‘Critical Care Echo Round’ (26). Finally, it should be emphasised that echocardiography is a useful adjunct, but not a substitute for clinical judgement.…”

Section: Hypovolaemiamentioning

confidence: 99%

CRITICAL CARE ECHO ROUNDS: Echo in cardiac arrest

Zafiropoulos¹,

Asrress²,

Redwood³

et al. 2014

Echo Research and Practice

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Management of medical cardiac arrest is challenging. The internationally agreed approach is highly protocolised with therapy and diagnosis occurring in parallel. Early identification of the precipitating cause increases the likelihood of favourable outcome. Echocardiography provides an invaluable diagnostic tool in this context. Acquisition of echo images can be challenging in cardiac arrest and should occur in a way that minimises disruption to cardiopulmonary resuscitation (CPR). In this article, the reversible causes of cardiac arrest are reviewed with associated echocardiography findings.CaseA 71-year-old patient underwent right upper lobectomy for lung adenocarcinoma. On the 2nd post-operative day, he developed respiratory failure with rising oxygen requirement and right middle and lower lobe collapse and consolidation on chest X-ray. He was commenced on high-flow oxygen therapy and antibiotics. His condition continued to deteriorate and on the 3rd post-operative day he was intubated and mechanically ventilated. Six hours after intubation, he became suddenly hypotensive with a blood pressure of 50 systolic and then lost cardiac output. ECG monitoring showed pulseless electrical activity. CPR was commenced and return of circulation occurred after injection of 1 mg of adrenaline. Focused echocardiography was performed, which demonstrated signs of massive pulmonary embolism. Thrombolytic therapy with tissue plasminogen activator was given and his condition stabilised.

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“…The evolution of echocardiography in acute settings was widely driven by the need for a rapid informative hemodynamic assessment. 1 The objective evolved from searching for a culprit cardiac pathology to a holistic but focused assessment of the entire circulatory system. 2 It differs from conventional exams by its urgency and the need for serial studies, so more conveniently provided by the primary clinician.…”

Section: Introductionmentioning

confidence: 99%

Echocardiography in the Assessment of Shock

Arshed,

Madhivathanan,

Roshdy

2024

Journal of Acute Care

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The skills, training, and approach can differ from one place to another, but it is generally recommended to follow a unique systematic approach in the same setting due to the usual need for serial studies by different operators.The study can be focused or comprehensive. A systemic approach makes it easier to reveal the shock etiology and spot the hemodynamic parameter in need of correction (e.g., flow obstruction, volume responsiveness, inotropes, and vasoconstrictors). It is important to note that several mechanisms can interplay and hence the need for a comprehensive approach.Based on our experience, we describe below our stepwise approach (Fig. 1):Step 1: Confirm Shock State This is usually a clinical diagnosis combined with biomarkers (e.g., mottling, capillary refill time, low urine output, lactate, and central venous oxygen saturation). However, some novel POCUS

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CRITICAL CARE ECHO ROUNDS: Haemodynamic instability

Cited by 9 publications

References 24 publications

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

CRITICAL CARE ECHO ROUNDS: Echo in cardiac arrest

Echocardiography in the Assessment of Shock

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