Evaluation of parameters used in echocardiography and ultrasound protocol for the diagnosis of shock etiology in emergency setting

Background Early recognition and appropriate treatment has shown to decrease morbidity and mortality in patients with undifferentiated shock. There are many ultrasound protocols in shock; each protocol combines core ultrasound elements such as IVC and cardiac assessment which includes detection of c...

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Published in:BMC emergency medicine 2023-11, Vol.23 (1), p.1-132, Article 132
Main Authors: Ramadan, Asmaa, Abdallah, Tamer, Abdelsalam, Hassan, Mokhtar, Ahmed, Razek, Assem Abdel
Format: Article
Language:English
Subjects:
Abdomen
Aorta
Bacterial pneumonia
Cardiac arrest
Causes and theories of causation
Coronary vessels
Development and progression
Diagnosis
Diseases
Echocardiography
Emergency medical care
Etiology
Health aspects
Heart
Medical diagnosis
Medical research
Medicine, Experimental
Morbidity
Mortality
Parameter sensitivity
Patients
Physicians
Pneumonia
Pneumothorax
Pulmonary embolisms
Respiration
Shock
Software
Taiwan
Tamponade
Ultrasonic imaging
Ultrasound
Veins & arteries
Ventricle
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Summary:Background Early recognition and appropriate treatment has shown to decrease morbidity and mortality in patients with undifferentiated shock. There are many ultrasound protocols in shock; each protocol combines core ultrasound elements such as IVC and cardiac assessment which includes detection of cardiac tamponade, left ventricular function and right ventricular strain.Valvular assessment is absent in majority of ultasound protocols, while lung ultrasound is included in some of them. Objective In this study we investigated which parameters used in Echo - US protocol help differentiate shock types. Methods This cross sectional study was conducted on 150 patients with shock (140 patients were included while, 10 patients were excluded).Sensitivity and specificity of different parameters used in the Echo-US protocol were analyzed to detect which parameters can diffentiate shock types. Results Velocity time integral of Aorta and IVC maximum diameter were good discriminators for distributive shock, with area under the ROC curve (AUC) = 0.8885 (95% CI 0.8144 to 0.9406) and 0.7728 (95% CI 0.6832 to 0.8473) (Z = 10.256 p < 0.0001) and (Z = 5.079 p < 0.0001) respectively. Left ventricular systolic function, presence of pneumonia, pneumothorax or valve vegetations were of great value in differentiating shock types, while CUST, FAST, TAPSE and RV diameter were not useful in differentiating shock types. Conclusion Ultrasound and echocardiography are powerful tools that can be used to identify shock etiology when the clinical picture overlaps. Keywords: Echocardiography, Ultrasound, Shock
ISSN:1471-227X
1471-227X
DOI:10.1186/s12873-023-00902-x