Value of Two-dimensional Echocardiography for Determining the Basis of Hemodynamic Compromise in Critically Ill Patients: A Prospective Study

Sanjiv Kaul, Alexander A. Stratienko, Stewart G. Pollock, Mark A. Marieb, Mark W. Keller, Peter J. Sabia

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    We postulated that because the first step in the management of critically ill patients with hypotension, pulmonary edema, or both is to determine whether the cause is cardiac or noncardiac, direct visualization of the heart with two-dimensional echocardiography would be useful for determining the basis of hemodynamic compromise in such patients. Accordingly, 49 consecutive patients (33 men and 16 women; mean age 61 ± 15 years) underwent two-dimensional echocardiography within 2 hours of placement of a pulmonary artery flotation catheter for determining the reason for hypotension, pulmonary edema, or both. To discriminate between cardiac and noncardiac causes, hemodynamic and two-dimensional echocardiographic data were evaluated independently by two to three blinded interpreters based on predetermined criteria. There was complete agreement between pulmonary artery catheter and two-dimensional echocardiographic data in 36 (86%) of the 42 patients in whom interpretable data were available in terms of cardiac versus noncardiac causes. The two modalities agreed in all patients with hypotension alone and disagreed in 2 of the 20 patients with pulmonary edema alone and 4 of the 14 patients with combined hypotension and pulmonary edema. In cases of discordance, the two tests provided complimentary information, particularly in patients with sepsis in whom the stroke volume may be normal to high but left ventricular systolic function may be depressed. The time taken for pulmonary artery catheter placement was 63 ± 45 minutes versus 19 ± 7 minutes for two-dimensional echocardiography. One patient had pneumothorax and cardiac arrest during pulmonary artery catheter placement. It is concluded that two-dimensional echocardiography is effective in determining the basis of hemodynamic compromise in critically ill patients. It could obviate the need for pulmonary artery catheter placement in most of these patients, and in those with sepsis it could provide information that is complimentary to that obtained from pulmonary artery catheterization.

    Original languageEnglish (US)
    Pages (from-to)598-606
    Number of pages9
    JournalJournal of the American Society of Echocardiography
    Issue number6
    StatePublished - Jan 1 1994


    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

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