Non-invasive hemodynamic evaluation by Doppler echocardiography

ABSTRACT The approach for treating a hemodynamically unstable patient remains a diagnostic and therapeutic challenge. Stabilization of the patient should be rapid and effective, but there is not much room for error. This narrow window of intervention makes it necessary to use rapid and accurate hemodynamic evaluation methods. Echocardiography is the method of choice for the bedside evaluation of patients in circulatory shock. In fact, it was intensive care physicians who recognized the potential of Doppler echocardiography for the initial approach to patients in circulatory failure. An echocardiogram allows rapid anatomical and functional cardiac evaluation, which may include non-invasive hemodynamic evaluation using a Doppler study. Such an integrated study may provide data of extreme importance for understanding the mechanisms underlying the hemodynamic instability of the patient to allow the rapid institution of appropriate therapeutic measures. In the present article, we describe the most relevant echocardiographic findings using a practical approach for critical patients with hemodynamic instability.

摘要 血流动力学不稳定患者的救治始终是一项诊断与治疗难题。对患者进行血流动力学稳定化处理需快速且有效，但容错空间极小。这一狭窄的干预窗口使得快速精准的血流动力学评估方法成为临床必需。超声心动图（echocardiography）是床旁评估循环休克患者的首选方法。事实上，正是重症监护医师率先认识到多普勒超声心动图（Doppler echocardiography）在循环衰竭患者初始诊疗中的应用价值。超声心动图可快速完成心脏解剖与功能评估，其中可涵盖通过多普勒检查实现的无创血流动力学评估。此类整合性检查可获取极为重要的数据，有助于明确患者血流动力学不稳定的潜在机制，从而能够快速实施恰当的治疗措施。在本文中，我们将以实用诊疗思路为框架，阐述血流动力学不稳定重症患者的相关关键超声心动图表现。