is a graduate of the Baylor College of Medicine Doctor of Nursing Practice (DNP) Program in Nurse Anesthesia, Houston, Texas. She is a CRNA at Houston Methodist Hospital, Houston, Texas. Email:
is the associate director of the DNP-Nurse Anesthesia Program at Baylor College of Medicine. She is an assistant professor in the college's Department of Anesthesiology and School of Health Professions. Dr Bullerwell served as senior author. Email:
AANA J. 2021 Apr;89(2):155-160.
Sustained hypotension impairs perfusion, causing permanent organ damage, neurologic deficit, and cardiac arrest. Emerging evidence suggests that noncardiac anesthesia providers can use echocardiography to manage refractory hypotension. Echocardiographic findings may reveal the underlying pathology of hemodynamic compromise and can guide the selection of appropriate resuscitative measures. The current evidence was reviewed to evaluate echocardiography's impact on the cause, diagnosis, and resuscitation management of refractory hypotension during noncardiac surgery. An extensive literature search yielded 3 prospective interventional studies and 7 observational studies, which were graded and ranked by quality, consistency, and strength of recommendations according to the United States Preventive Services Task Force evidence evaluation grading system. Echocardiographic imaging was useful in all phases of perioperative care, from the preoperative clinic through the postanesthesia care unit. Focused echocardiographic examination of the heart and great vessels contributed critical diagnostic data that expedited management decisions. As a primary cardiovascular monitor, transesophageal echocardiography guided both fluid resuscitation and pharmacologic therapy. During intraoperative cardiac arrest, transesophageal echocardiography enhanced diagnostic insight and directly guided targeted, lifesaving treatment. Noninvasive transthoracic echocardiography offered providers several clinical advantages. The published literature validates echocardiography's utility in the diagnosis and treatment of patients experiencing intraoperative refractory hypotension due to hemodynamic compromise.
持续低血压会损害灌注，导致永久性器官损伤、神经功能缺损和心脏骤停。新出现的证据表明，非心脏麻醉提供者可以使用超声心动图来管理难治性低血压。超声心动图的发现可能揭示血流动力学障碍的潜在病理，并可以指导选择适当的复苏措施。目前的证据进行了审查，以评估超声心动图对非心脏手术期间难治性低血压的原因、诊断和复苏管理的影响。广泛的文献检索产生了 3 项前瞻性干预性研究和 7 项观察性研究，根据美国预防服务工作组证据评估分级系统，根据质量、一致性和推荐强度对这些研究进行了分级和排名。超声心动图成像在围手术期护理的所有阶段都很有用，从术前诊所到麻醉后护理单位。对心脏和大血管的重点超声心动图检查提供了关键的诊断数据，加快了管理决策。作为主要的心血管监测器，经食管超声心动图指导液体复苏和药物治疗。在术中心脏骤停期间，经食管超声心动图增强了诊断洞察力，并直接指导了有针对性的、救生治疗。经胸超声心动图为提供者提供了几个临床优势。已发表的文献证实了超声心动图在诊断和治疗因血流动力学障碍而发生术中难治性低血压的患者中的实用性。
