Echocardiography for management of hypotension in the intensive care unit.

Hypotension is a common problem in critically ill patients. Rapid diagnosis and intervention may prevent this deterioration and improve eventual outcome. Echocardiography may make a critical difference in the rapid diagnosis of both common and uncommon but important causes of hypotension, such as pericardial tamponade. The differential diagnosis for hypotension differs between acutely admitted septic or trauma patients and the chronic patient in the intensive care unit. A better approach to patient evaluation is the performance of a comprehensive evaluation on every patient. A comprehensive examination is less likely to miss an unexpected diagnosis. With practice, a complete examination may be performed in minutes. Preload, contractility, systolic function (global and focal), and assessment of diastolic dysfunction (common cause of congestive heart failure) can be performed quickly. Specific situations like pericardial tamponade, pulmonary embolism, left ventricular outflow tract obstruction, unexplained hypoxemia, and aortic dissection, among others, can all be reliably performed using transesophageal echocardiography. Appropriate training and utilization of this technology will essentially help better manage hypotension in critically ill patients and thereby may improve their outcome. An algorithm to this effect has been suggested, although the same results can be achieved with different algorithms or approaches.