Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient?
OBJECTIVE
Transesophageal echocardiography (TEE) has proven its efficiency in assessing hemodynamics in patients by its ability to evaluate cardiac function and fluid responsiveness. Classically, it requires quantitative measurements, whereas in routine practice TEE is used in our unit especially as a qualitative procedure. We assessed the accuracy of this qualitative central hemodynamic evaluation obtained by TEE at the bedside.


METHODS
Prospective study conducted in a medical ICU between September 2004 and April 2005. All TEE examinations performed in consecutive patients hospitalized for septic shock and mechanically ventilated for an associated acute lung injury were eligible for evaluation. Intensivists trained in echocardiography were asked to classify (a) respiratory changes in the superior vena cava (SVC), (b) left ventricular (LV) systolic function, (c) right ventricular (RV) end-diastolic size, and (d) shape and kinetics of the interventricular septum (IVS). A post-hoc quantitative evaluation was then performed by a trained investigator unaware of the patients' status.


RESULTS
We evaluated 83 examinations in 30 patients. Qualitative evaluation was easily able to distinguish patients with significant or nonsignificant SVC respiratory changes, normal, moderately or markedly depressed LV systolic function, and nondilated or dilated right ventricle. Acute cor pulmonale was also well recognized.


CONCLUSIONS
By its ability accurately to evaluate hemodynamic status qualitative TEE could be useful for intensivists in managing circulatory failure in septic shock, rendering the more time-consuming quantitative evaluation useless.
Vieillard-Baron
Antoine
A
University Hospital Ambroise Paré, Assistance Publique Hôpitaux de Paris, Medical Intensive Care Unit, 9 avenue Charles de Gaulle, 92104 Boulogne Cedex, France. antoine.vieillard-baron@apr.aphp.fr
Charron
Cyril
C
Chergui
Karim
K
Peyrouset
Olivier
O
Jardin
François
F
D000368:Aged; D000704:Analysis of Variance; D003971:Diastole; D017548:Echocardiography, Transesophageal; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000000981:diagnostic imaging*; D013599:Systole; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging