Evaluación del gasto cardiaco mediante la utilización del flujo Doppler aórtico en el paciente en Shock

Abstract

The primary goal of shock management is to ensure adequate blood and oxygen delivery to the various tissues. To achieve this goal, assessment of cardiac output (CO) is essential to characterize the type of shock, to initiate treatment and to evaluate the response to such therapy. Although transcardiac thermodilution by right heart catheterization has traditionally been the reference method for obtaining CO, several studies have confirmed that its early use in patients in shock or respiratory distress was not only not associated with a significant improvement in morbidity and mortality, but could also lead to serious complications related to its invasive nature. For these reasons, the last decade has seen the introduction of less invasive techniques for calculating CO in intensive care units (ICUs). Among these, transthoracic echocardiography has emerged as a promising technique in the ICU, as it would allow a non-invasive, early, accurate and simple assessment to be performed in the ICU by physicians with basic training. However, there is currently insufficient literature to validate its routine use as an alternative method of calculating CO. In this context, the present thesis is based on the need to validate the use of Doppler echocardiography as a method of estimating CO in critically ill patients admitted to an Intensive care unit. The research is supported by scientific evidence from two studies carried out in the intensive care unit of the Joan XXIII Hospital and published in scientific journals of interest in the field of intensive care medicine. The main results showed that there was adequate agreement between the cardiac output measured by Doppler echocardiography and the CO estimated by transcardiac thermodilution with intra- and interobserver variability, despite being performed by intensivists with basic training in critical care echocardiography. It was also found that the minute distance provides a simple and equally accurate estimate of CO, despite the exclusion of the left ventricular output tract diameter (dTSVI) in the measurement. We believe that the results of this investigation could have a major impact on the daily management of our patients, in terms of improving their circulatory status with normalization of organ failure, avoiding the need for invasive monitoring methods. This could also lead to an improvement in patient morbidity and mortality.

Date of Award	12 Dec 2023
Original language	Spanish
Supervisor	Emilio Diaz Santos (Director) & Alejandro Hugo Rodriguez Oviedo (Director)