Role of echocardiography in the management of shock

Hemodynamic instability and inade-quate cardiac performance is frequently found in critically ill patients. Tran-sthoracic and transesophageal (in the case of inadequate visibility) echocar-diography is increasingly used for non-invasive hemodynamic assessment and monitoring in the ICU setting. Using echocardiography, it is possible to assess preload, fluid responsiveness, systolic and diastolic cardiac function, and cal-culate cardiac output, intravascular and intra-cardiac pressures. It is the golden standard in the initial hemodynamic assessment and should be used as com-plementary tool in invasively monitored patients in the case of new circulatory or respiratory failure. Echocardiography is indispensable in the management of shock patients and is extremely power-ful diagnostic role for the cardiac abnor-malities (pericardial effusion and tam-ponade, acute cor pulmonale and acute or chronic valvular disorders) as a cause for hemodynamic instability. It is the most important and suitable method for assessment of right ventricular function, for diagnosis of septic cardiomyopathy and cardiac causes of weaning failure. Because of these advantages it should be routinely used by intensivists for hemo-dynamic assessment and monitoring and should be continuously available in the intensive care unit. The most important limitations of echocardiography are its inability to estimate adequacy of car-diac output and its intermittent nature. Therefore it should be used in rational combination with other complementary and continuous monitoring methods.

echocardiography, circulatory shock, critically ill patients

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