Multiorgan evaluation of perfusion and congestion using ultrasound in patients with shock

Tavazzi, Guido; Spiegel, Rory; Rola, Philippe; Price, Susanna; Corradi, Francesco; Hockstein, Maxwell A.

doi:10.1093/ehjacc/zuad025

Cited by 12 publications

(7 citation statements)

References 61 publications

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“…This could be evaluated by the changes from pulsatile to discontinuous or, in the most advance cases, blunted flow during diastole (Fig. 5) [50 ▪▪ ] and was associated with the outcome in patients with either left and right heart failure [51].…”

Section: Abdominal Ultrasoundmentioning

confidence: 99%

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Multimodality imaging in cardiogenic shock: state-of-the art

Tavazzi

Corradi

Vandenbriele

et al. 2023

Current Opinion in Critical Care

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Purpose of review There is emerging evidence on the role of the multimodality imaging in the setting of cardiogenic shock. The utility of different imaging modalities, along with their pitfalls and limitations, and their integration in a multiparametric approach are discussed in the current review. Recent findings The evaluation of congestion and perfusion in patients with shock has allowed a better understanding of the underlying physiopathological mechanisms. Integration of echocardiography, using more physiological parameters, with lung ultrasound, as well as the Doppler evaluation of abdominal blood flow dynamics, has led to a better stratification in patinas with hemodynamic instability. Summary Although validation of the integrated approaches and single parameters are needed, the physiopathological-driven approach using ultrasound in patients with cardiogenic shock on top of the clinical and biochemical evaluation, may aid to a quicker and more detailed evaluation of patient's phenotype.

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Section: Abdominal Ultrasoundmentioning

confidence: 99%

“…Although a strict correlation exists between liver function, and its investigation through Doppler ultrasound at the level of portal and hepatic veins, no specific investigation has performed in cardiogenic shock so far. However, a pathophysiological-driven approach has recently been proposed [50 ▪▪ ].…”

Section: Abdominal Ultrasoundmentioning

confidence: 99%

Multimodality imaging in cardiogenic shock: state-of-the art

Tavazzi

Corradi

Vandenbriele

et al. 2023

Current Opinion in Critical Care

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“…Most of the ultrasonographic studies on congestion came from the application of VEXUS protocols in cardiologic patients with varying degrees of right and/or left cardiac dysfunction and concomitant fluid overload [9]. However, our results, collected in a population of elective surgical patients submitted to a strict ERAS protocol without known cardiac pathologies or signs of heart decompensation, showed postoperative Doppler signs of splanchnic congestion even in the absence of dilatation of the inferior vena cava, thus suggesting the absence of fluid overload.…”

Section: Discussionmentioning

confidence: 99%

“…Point-of-care ultrasonography (POCUS) with arterial Doppler assessment enables clinicians to assess organ-specific blood supply in both arteries and veins [9,10]. Recently, Doppler patterns of intrarenal venous flow (IRVF) have been described to predict acute kidney injury (AKI) and post-surgical complications after open heart surgery [11].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Renal Ultrasonography of Arterio-to-Venous Coupling Predicts Postoperative Complications after Major Laparoscopic Urologic Surgery

Brusasco,

Tavazzi,

Cucciolini

et al. 2023

JCM

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Point-of-care ultrasonography (POCUS) with concomitant venous and arterial Doppler assessment enables clinicians to assess organ-specific blood supply. To date, no studies have investigated the usefulness of including a comprehensive perioperative POCUS assessment of patients undergoing major laparoscopic surgery. The primary aim of the present study was to evaluate whether the combined venous and arterial renal flow evaluation, measured at different time points of perioperative period, may represent a clinically useful non-invasive method to predict postoperative acute kidney injury (AKI) after major laparoscopic urologic surgery. The secondary outcome was represented by the development of any postoperative complication at day 7. We included 173 patients, subsequently divided for analysis depending on whether they did (n = 55) or did not (n = 118) develop postoperative AKI or any complications within the first 7 days. The main results of the present study were that: (1) the combination of arterial hypoperfusion and moderate-to-severe venous congestion inferred by POCUS were associated with worst outcomes (respectively, HR:2.993, 95%CI:1.522–5.884 and HR:8.124, 95%CI:3.542–18, p < 0.001); (2) high intra-operative abdominal pressure represents the only independent determinant of postoperative severe venous congestion (OR:1.354, 95%CI:1.017–1.804, p = 0.038); (3) the overall number of complications relies on the balance between arterial inflow and venous outflow in order to ensure the adequacy of peripheral perfusion; and (4) the overall reliability of splanchnic perfusion assessment by Doppler is high with a strong inter-rater reliability (ICC:0.844, 95%CI:0.792–0.844). The concomitant assessment of arterial and venous Doppler patterns predicts postoperative complications after major laparoscopic urologic surgery and may be considered a useful ultrasonographic biomarker to stratify vulnerable patients at risk for development of postoperative complications.

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“… 8 Not only TTE and TOE but also vascular and lung ultrasound are useful and should be used in patients with CS to assess end-organ perfusion and congestion. 18 Renal and splenic Doppler resistive indices as well as transcranial Doppler ultrasound may be used to assess renal, splenic, and cerebral perfusion, respectively. Systemic congestion can be assessed by the evaluation of inferior vena cava diameter and collapsibility but also by analyzing the intra-renal, hepatic, and portal venous flow with Doppler ultrasound.…”

Section: Invasive and Non-invasive Hemodynamic Monitoring Systems In ...mentioning

confidence: 99%

Management of temporary mechanical circulatory support devices in cath-lab and cardiac intensive care unit

Fortuni

Zilio

Iannopollo

et al. 2023

European Heart Journal - Imaging Methods and Practice

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Different temporary mechanical circulatory support (tMCS) devices are available and can be used to maintain end-organ perfusion while reducing cardiac work and myocardial oxygen demand. tMCS can provide support to the right ventricle, left ventricle, or both, and its use can be considered in emergency situations such as cardiogenic shock or in in elective procedures such as high-risk percutaneous coronary intervention to prevent hemodynamic deterioration. Invasive and, most importantly, non-invasive hemodynamic parameters should be taken into account when choosing the type of tMCS device and its initiation and weaning timing, determining the need for a device upgrade, and screening for complications. In this context, ultrasound tools, specifically echocardiography, can provide important data. This review aims to provide a description of the different tMCS devices, of the invasive and non-invasive tools and parameters to guide their management, and their advantages and drawbacks.

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Multiorgan evaluation of perfusion and congestion using ultrasound in patients with shock

Cited by 12 publications

References 61 publications

Multimodality imaging in cardiogenic shock: state-of-the art

Multimodality imaging in cardiogenic shock: state-of-the art

Perioperative Renal Ultrasonography of Arterio-to-Venous Coupling Predicts Postoperative Complications after Major Laparoscopic Urologic Surgery

Management of temporary mechanical circulatory support devices in cath-lab and cardiac intensive care unit

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