Aurora Critical Care Services, St Luke's Medical Center, Milwaukee, Wisconsin.
Department of Cardiovascular Anesthesiology and Critical Care Medicine, Baylor St Luke's Medical Center-The Texas Heart Institute, Houston, Texas.
Tex Heart Inst J. 2023 Oct 16;50(5). doi: 10.14503/THIJ-22-8075.
The clinical approach to undifferentiated shock in critically ill patients should be revised to use modern, point-of-care tools that are readily available. With the increasing availability of 2-dimensional ultrasonography and advanced Doppler capabilities, a quick, simplified, and integrated stepwise approach to shock using critical care echocardiography is proposed. Evidence supports the feasibility and usefulness of critical care echo-cardiography in enhancing diagnostic accuracy for shock, but there is a lack of systematic application of the technology in patients with undifferentiated shock. The proposed approach begins with the use of noninvasive ultrasonography with pulsed-wave Doppler capability to determine the flow state by measuring the velocity time integral of the left ventricular outflow tract. This narrative review explores the use left ventricular outflow tract velocity time integral, velocity time integral variation, limited visceral organ Doppler, and lung ultrasonography as a systematic approach for patients with undifferentiated shock.
对于危重症患者的未分化性休克，临床处理方法应进行修正，采用现代即时检测工具。随着二维超声和高级多普勒技术的广泛应用，提出了一种使用重症超声心动图对休克进行快速、简化和综合的分步诊断方法。有证据支持重症超声心动图在提高休克诊断准确性方面的可行性和有效性，但该技术在未分化性休克患者中缺乏系统应用。所提出的方法首先使用具有脉冲波多普勒功能的非侵入性超声来测量左心室流出道的速度时间积分，以确定血流状态。本综述探讨了使用左心室流出道速度时间积分、速度时间积分变化、有限的内脏器官多普勒和肺部超声作为未分化性休克患者的系统诊断方法。
