The use of echocardiography in the management of shock in critical care: a prospective, multi-centre, observational study.

Autor: Flower L; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK. luke.flower@doctors.org.uk.; Department of Critical Care, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK. luke.flower@doctors.org.uk.; London School of Intensive Care Medicine, London, UK. luke.flower@doctors.org.uk., Waite A; North West Deanery School of Intensive Care Medicine, Liverpool, UK.; University of Liverpool, Liverpool, UK.; Department of Critical Care, Liverpool University Hospitals NHS Trust, Liverpool, UK., Boulton A; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK., Peck M; Department of Anaesthesia and Critical Care, Royal Hampshire County Hospital, Winchester, UK., Akhtar W; Department of Critical Care, Guys & St Thomas' NHS Foundation Trust, London, UK., Boyle AJ; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.; Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland., Gudibande S; Department of Critical Care, Lancashire Teaching Hospitals NHS Trust, Lancashire, UK.; Professional Affairs and Standards Committee, Faculty of Intensive Care Medicine, London, UK., Ingram TE; Department of Cardiology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK., Johnston B; University of Liverpool, Liverpool, UK.; Department of Critical Care, Liverpool University Hospitals NHS Trust, Liverpool, UK., Marsh S; Department of Critical Care, Harrogate and District NHS Foundation Trust, Harrogate, UK., Miller A; Department of Critical Care, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK., Nash A; NHS England Wessex School of Anaesthesia, Wessex, UK., Olusanya O; Department of Critical Care, Barts Health NHS Trust, London, UK., Parulekar P; Department of Critical Care, William Harvey Hospital, Ashford, UK., Wagstaff D; Wessex School of Intensive Care Medicine, NHS England, Wessex, UK., Wilkinson J; Department of Critical Care, Northampton General Hospital, Northampton, UK., Proudfoot AG; Department of Critical Care, Barts Health NHS Trust, London, UK.; Critical Care and Perioperative Medicine Group, School of Medicine and Dentistry, Queen Mary University London, London, UK.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2024 Oct; Vol. 50 (10), pp. 1668-1680. Date of Electronic Publication: 2024 Aug 19.
DOI: 10.1007/s00134-024-07590-6
Abstrakt: Purpose: Echocardiography is recommended as a first-line tool in the assessment of patients with shock. The current provision of echocardiography in critical care is poorly defined. The aims of this work were to evaluate the utilisation of echocardiography in patients presenting to critical care with shock, its impact on decision making, and adherence to governance guidelines.
Methods: We conducted a prospective, multi-centre, observational study in 178 critical care units across the United Kingdom (UK) and Crown Dependencies, led by the UK's Trainee Research in Intensive Care Network. Consecutive adult patients (≥ 18 years) admitted with shock were followed up for 72 h to ascertain whether they received an echocardiogram, the nature of any scan performed, and its effect on critical treatment decision making.
Results: 1015 patients with shock were included. An echocardiogram was performed on 545 (54%) patients within 72 h and 436 (43%) within 24 h of admission. Most scans were performed by the critical care team (n = 314, 58%). Echocardiography was reported to either reduce diagnostic uncertainty or change management in 291 (54%) cases. Patients with obstructive or cardiogenic shock had their management altered numerically more often by echocardiography (n = 15 [75%] and n = 100 [58%] respectively). Twenty-five percent of echocardiograms performed adhered to current national governance and image storage guidance.
Conclusion: Use of echocardiography in the assessment of patients with shock remains heterogenous. When echocardiography is used, it improves diagnostic certainty or changes management in most patients. Future research should explore barriers to increasing use of echocardiography in assessing patients presenting with shock.
(© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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