Implication of Transthoracic Sonography in Assessment of Circulatory Failure: Fayoum Experience With Falls Protocol

Abstract

SESSION TITLE: Rapid Session: Bedside Imaging SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 07:30 AM - 08:30 AM PURPOSE: Acute circulatory failure is one of the most familiar concerns of the Intensivists. The assessment of acute circulatory failure is a challenge in absence of solid gold standard. It is suggested that artifacts generated by lung ultrasound can be of help. The aim of this study was to evaluate the efficiency of transthoracic ultrasound (TUS) in hemodynamic assessment of shock. METHODS: This study included 63 ICU patients with circulatory shock at Fayoum university hospital.All patients were studied with TUS using FALLS protocol (Fluid Administration Limited by Lung Sonography). The FALLS-protocol followed Weil’s classification of shocks. TUS artifacts and outcomes were compared with definite final diagnosis according to history, clinical examination, laboratory investigations, chest x- ray, echocardiography, CT pulmonary angiography or other diagnostic tools. RESULTS: Obstructive shock was the presentation in 18 patients. TUS using FALLS protocol detected this category of shock in 4 patients with pericardial tamponade, 8 cases of tension pneumothorax and 3 cases of pulmonary embolism with a sensitivity and specificity of 83% and 100% respectively. Cardiogenic shock was demonstration in 15 patients. Using B profile; TUS was absolutely sensitive and specific for diagnosis of this entity of shock. Hypovolemic shock was detected in 20 patients. A profile by TUS with response to fluid therapy was demonstrated in 18 patients with a sensitivity and specificity of 90% each. On the other hand, A profile converting to B profile by fluid therapy was observed in 8 patients out of 10 presenting with septic shock giving a sensitivity of 80% and a specificity of 85%. CONCLUSIONS: TUS utilizing FALLS protocol is a simple, bedside, noninvasive, cheap, and rapid effective tool in sequential diagnosis of obstructive, cardiogenic, hypovolemic, and septic shock. CLINICAL IMPLICATIONS: TUS is a fast, inexpensive, widely available bed-side diagnostic tool that should be applied in rapid hemodynamic assessment of circulatory failure in intensive care units. DISCLOSURE: The following authors have nothing to disclose: Gamal Agmy, Randa Ahmed, Alliaa Mohamed, Sherif Hamed, Mohamed Saad No Product/Research Disclosure Information