Echocardiography in the sepsis syndromes

Abstract

Purpose of the review Non-invasiveness and instantaneous diagnostic capability are prominent features of the use of echocardiography in critical care. Sepsis and septic shock represent complex situations where early hemodynamic assessment and support are among the keys to therapeutic success. In this review, we discuss the range of applications of echocardiography in the management of the septic patient, and propose an echocardiography-based goal-oriented hemodynamic approach to septic shock. Recent findings Echocardiography can play a key role in the critical septic patient management, by excluding cardiac causes for sepsis, and mostly by guiding hemodynamic management of those patients in whom sepsis reaches such a severity to jeopardize cardiovascular function. In recent years, there have been both increasing evidence and diffusion of the use of echocardiography as monitoring tool in the patients with hemodynamic compromise. Also thanks to echocardiography, the features of the well-known sepsis-related myocardial dysfunction have been better characterized. Furthermore, many of the recent echocardiographic indices of volume responsiveness have been validated in populations of septic shock patients. Conclusion Although not proven yet in terms of patient outcome, echocardiography can be regarded as an ideal monitoring tool in the septic patient, as it allows (a) first line differential diagnosis of shock and early recognition of sepsis-related myocardial dysfunction; (b) detection of preexisting cardiac pathology, that yields precious information in septic shock management; (c) comprehensive hemodynamic monitoring through a systematic approach based on repeated bedside assessment; (d) integration with other monitoring devices; and (e) screening for cardiac source of sepsis.

Make it SIMPLE: enhanced shock management by focused cardiac ultrasound

“…Septic shock represents a distinctive spectrum of hemodynamic instability. In the early stage, the afterload is reduced and left ventricular dysfunction, although present, is masked by the severely reduced afterload due to sepsis [ 61 , 62 ]. Thus, FoCUS will find a normal LVEDA but small left ventricular end-systolic area (LVESA) and a hyperdynamic LV.…”

Relation of Echocardiographic Parameters to Outcome of Patients with Severe Sepsis and Septic Shock

“…Echocardiography has now a day acknowledged and is increasingly used in critical care as an irreplaceable tool in the management of the critical patient. 8 Key recommendations according to international guidelines for management of severe sepsis and septic shock considering well known fact that, myocardial dysfunction is frequent in patient with septic shock with more than 90% systolic and more than 75% diastolic dysfunction in present cohort of septic shock, which favor inclusion of bedside echocardiography for early quantitative and goal-directed resuscitation of the septic patient. 9 Intensivists can safely and accurately perform goal-oriented echocardiography.…”

Point‐of‐care ultrasound with pocket‐size devices in emergency department

“…In this type of circulatory shock cardiac chambers are generally normal with preserved contractility except in the case of sepsis‐related cardiomyopathy. Septic shock is one of the most complex hemodynamic failure syndromes because it may imply absolute or relative reduction in central fluid volume, peripheral vasodilatation, and myocardial failure . In patients with septic shock, echocardiography can be used to assess fluid responsiveness by measuring variation in dimension and collapsibility of the inferior vena cava or by measuring stroke volume variation and its surrogates during fluid administration, to diagnose sepsis‐induced myocardial dysfunction and to monitor responses to therapy by evaluation of myocardial contractility during inotropes and vasopressors therapy and by evaluation of pulmonary wetness during fluid administration .…”