Not all Shock States Are Created Equal

Khorsand, Sarah; Helou, Mada F.; Satyapriya, Veena; Kopanczyk, Rafal; Khanna, Ashish K.

doi:10.1016/j.anclin.2022.11.002

Cited by 4 publications

(2 citation statements)

References 118 publications

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“…All had septic shock and all received vasopressor support in the form of norepinephrine (table 1). Table (2) presented the hemodynamics and ultrasonography measurements before and after fluid administration. These results reveal that, the MAP significantly increased and HR significantly decreased after procedure than their corresponding values before procedure.…”

Section: Resultsmentioning

confidence: 99%

Ultrasound Guided Measurement of Inferior Vena Cava Diameter, Common Carotid Artery Diameter versus Central Venous Pressure for Estimation of Intravascular Volume Status in Septic Shock Patients

Ali,

Salem,

Elghonimy

et al. 2024

SJMS

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Background: In critically ill patients, the fluid resuscitation is crucial and is the first step in treatment protocol. Invasive CVP measurement was used to guide fluid resuscitation. However, it is time consuming and invasive maneuver. Ultrasound measurement of inferior vena cave and common carotid arteries are suggest to predict the fluid response as well as CVP or even better. The current work designed to compare inferior vena cava diameter and common carotid artery diameter with central venous pressure for estimation of intravascular volume status in septic shock. Patients and Methods: The study included 60 subjects with septic shock who received vasopressor support. CVP and ultrasound were performed before and after fluid challenge test. Values of inferior vena cava and common carotid arteries were documented and compared to CVP values. This was performed after full clinical assessment by detailed clinical examination and laboratory workup. Results: The MAP was significantly increased and HR decreased after than before procedure. In addition, CVP, (inferior vena cava), ICVmax, ICV min and common carotid artery diameter (CCAD) were significantly increased, IVC CI (%) was significantly reduced after procedure than basal values. There was significant decrease of IVCmax, IVCmin and CCAD while there was significant increase of IVC CI% with lower (<8) than higher (> 8) CVP values. CVP was positively and significantly correlated with IVCmax, IVCmin and CCAD, while it was inversely correlated with IVC CI%. The AUC was over 0.75 for IVCmax, IVCmin and CCAD for prediction of CVP while it was lower than 0.7 for IVC CI%. These data reflected the better predictive power of IVCmax, IVCmin and CCAD. The best cutoff value was 1.35, 1.25, 10.45 and 4.15 for IVCmax, IVCmin, IVC CI% and CCAD successively. Conclusion: IVC and CCA diameters measurement by US may replace CVP measurement for estimation of intravascular volume status in septic shock patients.

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Section: Resultsmentioning

confidence: 99%

Ultrasound Guided Measurement of Inferior Vena Cava Diameter, Common Carotid Artery Diameter versus Central Venous Pressure for Estimation of Intravascular Volume Status in Septic Shock Patients

Ali,

Salem,

Elghonimy

et al. 2024

SJMS

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“…While initial presentation of shock includes evidence of hypoperfusion and hypotension, not all such states are equal (Figure 1). 27 Cardiogenic shock (CS) is a continuum of hemodynamic instability, including isolated hypotension with preserved organ perfusion, isolated organ hypoperfusion despite preserved blood pressure, and the combination of hypotension and hypoperfusion. 1 Figure 2 shows the Society for Cardiovascular Angiography & Interventions classification of CS, which aims to provide a Figure 1 Society of Cardiovascular Angiography and Interventions (SCAI) classification of cardiogenic shock.…”

Section: Choosing Pressure Versus Indicators Of Tissue Perfusion When...mentioning

confidence: 99%

Blood Pressure Goals in Critically Ill Patients

Rajkumar¹,

Hicks²,

Marchant

et al. 2023

Methodist DeBakey Cardiovascular Journal

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Blood pressure goals in the intensive care unit (ICU) have been extensively investigated in large datasets and have been associated with various harm thresholds at or greater than a mean pressure of 65 mm Hg. While it is difficult to perform interventional randomized trials of blood pressure in the ICU, important evidence does not support defense of a higher pressure, except in retrospective database analyses. Perfusion pressure may be a more important target than mean pressure, even more so in the vulnerable patient population. In the cardiac ICU, blood pressure targets are tailored to specific cardiac pathophysiology and patient characteristics. Generally, the goal is to maintain adequate blood pressure within a certain range to support cardiac function and to ensure end organ perfusion. Individualized targets demand the use of both invasive and noninvasive monitoring modalities and frequent titration of medications and/or mechanical circulatory support where necessary. In this review, we aim to identify appropriate blood pressure targets in the ICU, recognizing special patient populations and outlining the risk factors and predictors of end organ failure.

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