1247статья из журнала
Аннотация: Introduction: Echocardiography is used to assess right and left ventricular size and function, wall motion abnormalities, filling volumes, and valvular disease. It is noninvasive and is a valuable tool in the assessment of critically ill patients. We present a case of stress-induced cardiomyopathy in a patient initially presumed to be in septic shock. Case description: A 44 year-old female presented to a community hospital for acute on chronic abdominal pain exacerbation. Past medical history was significant for open gastric bypass surgery complicated by chronic abdominal pain with narcotic dependence. She acutely decompensated after admission with hypotension, tachycardia, leukopenia, hypoxemia, and lactic acidosis prompting ICU transfer for initiation of vasopressors and empiric antibiotics. Despite unremarkable imaging on admission to the hospital, the patient was taken for emergent laparotomy for suspected bowel ischemia, which revealed pink, viable bowel. A rash was then discovered over her left flank suspicious for a necrotizing skin infection. She developed anuria and was transferred to our institution intubated with presumed septic shock. She received aggressive fluid resuscitation in transit and arrived on high dose norepinephrine and vasopressin with a MAP of 45, CVP of 28, lactate 9.3, troponin 0.01 and WBC 0.4. Transthoracic echocardiogram revealed severe left ventricular systolic dysfunction and apical ballooning highly suggestive of stress-induced cardiomyopathy. Interventions were redirected towards unloading the left ventricle with an intra-aortic balloon pump and cessation of fluid resuscitation. Despite the late recognition of the cardiomyopathy, after multiple rounds of ACLS for PEA the family transitioned the patient to comfort care. Postmortem revealed no evidence of infection. Discussion: Surviving sepsis guidelines advocate aggressive fluid resuscitation with goals set for MAP, CVP, urine output, and MVO2. These guidelines do not account for patients with acute right or left ventricular dysfunction. Early bedside echocardiography may assist in diagnosis in hypotensive patients, avoid unnecessary procedures, and improve outcomes.
Год издания: 2013
Авторы: Samuel Gilliland, Breandan Sullivan
Издательство: Lippincott Williams & Wilkins
Источник: Critical Care Medicine
Ключевые слова: Intensive Care Unit Cognitive Disorders, Muscle and Compartmental Disorders
Открытый доступ: closed
Том: 41
Страницы: A320–A321