Hemodynamic monitoring in cardiogenic shock

VanDyck, Tyler; Pinsky, Michael R.

doi:10.1097/mcc.0000000000000838

Cited by 19 publications

(16 citation statements)

References 35 publications

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“…In the settings of undifferentiated shock, pulmonary artery catheterization may be a useful tool in distinguishing between cardiogenic and septic etiologies. 3 This patient had an elevated central venous pressure of 21 mmHg, pulmonary arterial mean pressure of 35 mmHg, and pulmonary capillary wedge pressure of 26 mmHg, with a prominent decrease in cardiac index to 1.46 l/min and a mixed venous oxygen saturation of 50%, suggestive of a cardiogenic etiology of his shock. The patient was kept on broad-spectrum antibiotics to cover for a possible underlying infection complicating his shock.…”

mentioning

confidence: 84%

Clozapine-induced Cardiomyopathy: A Case Report

Hariri

Scandinaro

Hammoud

et al. 2023

USC

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The diagnosis and treatment of new-onset systolic dysfunction can be challenging, particularly in patients presenting with cardiogenic shock. We present a case of a young African-American male who was admitted for cardiogenic shock following an admission a month earlier for treatmentresistant psychosis. He was diagnosed with medication-induced cardiomyopathy, which resolved with a remarkable recovery of his systolic function after discontinuation of the culprit medication, clozapine.

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mentioning

confidence: 84%

Clozapine-induced Cardiomyopathy: A Case Report

Hariri

Scandinaro

Hammoud

et al. 2023

USC

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“…The use of POCUS checklists may also be considered [29]. For haemodynamic diagnosis and monitoring, numerous invasive and non‐invasive tools are in widespread use across ICUs [30, 31]. However, each carries risks of misinterpretation, even simple technologies such as direct arterial pressure monitoring [32], which can be largely circumvented by good education and awareness.…”

Section: Diagnostic Processmentioning

confidence: 99%

Difficult diagnosis in the ICU: making the right call but beware uncertainty and bias

et al. 2023

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Dealing with an uncertain or missed diagnosis is commonplace in the intensive care unit setting. Affected patients are subject to a potential decrease in quality of care and a greater risk of a poor outcome. The diagnostic process is a complex task that starts with information gathering, followed by integration and interpretation of data, hypothesis generation and, finally, confirmation of a (hopefully correct) diagnosis. This may be particularly challenging in the patient who is critically ill where a good history may not be forthcoming and/or clinical, laboratory and imaging features are non-specific. The aim of this narrative review is to analyse and describe common causes of diagnostic error in the intensive care unit, highlighting the multiple types of cognitive bias, and to suggest a diagnostic framework. To inform this review, we performed a literature search to identify relevant articles, particularly those pertinent to unclear diagnoses in patients who are critically ill. Clinicians should be cognisant as to how they formulate diagnoses and utilise debiasing strategies. Multidisciplinary teamwork and more time spent with the patient, supported by effective and efficient use of electronic healthcare records and decision support resources, is likely to improve the quality of the diagnostic process, patient care and outcomes.

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“…However, in the particular case of cardiogenic shock, multiple recent studies support the use of the PAC in the population of patients in cardiogenic shock [44,45 ▪ ]. These recent observational studies, several of which were included in a recent meta-analysis [46], showed that patients monitored by PAC had lower mortality than those not monitored by the system [47,48].…”

Section: Does Advanced Monitoring Improve the Prognosis Of Critically...mentioning

confidence: 99%

Which haemodynamic monitoring should we chose for critically ill patients with acute circulatory failure?

Monnet

Lai

2023

Current Opinion in Critical Care

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Purpose of reviewTo discuss the suitable haemodynamic monitoring for critically ill patients with shock.Recent findingsFor the basic initial monitoring, recent studies emphasized the importance of clinical signs of hypoperfusion and arterial pressure. This basic monitoring is not sufficient in patients resisting to initial treatment. Echocardiography does not allow multidaily measurements and has limitations, for measuring right or left ventricular preload. For a more continuous monitoring, noninvasive and minimally invasive tools are insufficiently reliable, as recently confirmed, and informative. The most invasive techniques, transpulmonary thermodilution and the pulmonary arterial catheter are more suitable. Their effect on outcome is lacking, although recent studies showed their benefit in acute heart failure. For assessing tissue oxygenation, recent publications better defined the meaning of the indices derived from the partial pressure of carbon dioxide. The integration of all data by artificial intelligence is the subject of early research in critical care.SummaryFor monitoring critically ill patients with shock, minimally or noninvasive systems are not reliable or informative enough. In the most severe patients, a reasonable monitoring policy can combine continuous monitoring by transpulmonary thermodilution systems or the pulmonary arterial catheter, with an intermittent assessment with ultrasound and measurement of tissue oxygenation.

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Hemodynamic monitoring in cardiogenic shock

Cited by 19 publications

References 35 publications

Clozapine-induced Cardiomyopathy: A Case Report

Clozapine-induced Cardiomyopathy: A Case Report

Difficult diagnosis in the ICU: making the right call but beware uncertainty and bias

Which haemodynamic monitoring should we chose for critically ill patients with acute circulatory failure?

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