Abstract
Cardiogenic shock (CS) is associated with a high in-hospital mortality despite the achieved advances in diagnosis and management. Invasive mechanical ventilation and circulatory support constitute the highest step in cardiogenic shock therapy. Once established, taking the decision of weaning from such support is challenging. Intensive care unit (ICU) bedside echocardiography provides noninvasive, immediate, and low-cost monitoring of hemodynamic parameters such as cardiac output, filling pressure, structural disease, congestion status, and device functioning. Supplemented by an ultrasound of the lung and diaphragm, it is able to provide valuable information about signs suggesting a weaning failure. The aim of this article was to review the state of the art taking into account current evidence and knowledge on ICU bedside ultrasound for the evaluation of weaning from mechanical ventilation and circulatory support in cardiogenic shock.
Highlights
A total of 50–80% of patients with Society for Cardiovascular Angiography and Intervention (SCAI) classification stage C or D cardiogenic shock may require initiation of mechanical ventilation (MV) due to left-ventricular dysfunction and elevated filling pressure leading to pulmonary edema, oxygenation impairment, and the increased work of breathing with ventilatory muscle fatigue [2,3]
There are two proposed parameters for assessing weaning failure: diaphragmatic excursion (DE), which measures the distance that the diaphragm moves during a spontaneous, unassisted respiratory cycle, and the diaphragm thickening fraction (DTF), which reflects variation in the thickness of the diaphragm as a measure of muscle contraction during the cycle
Veno-arterial Extracorporeal Membrane Oxygenation (ECMO) support is increasingly used in pharmacological refractory cardiogenic shock as a bridge to recovery, during heart transplantation, or as a bridge to a long-term left-ventricular assist device
Summary
Rebeca Muñoz-Rodríguez * , Martín Jesús García-González, Pablo Jorge-Pérez, Marta M.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have