Middle East Heart Congress

Circulatory shock is common in the ICU, approximately one- third of patients admitted to ICU have circulatory shock. Septic shock is the most common presentation followed by cardiogenic , hypovolemic and infrequently obstructive shock. Most reports of cardiogenic shock pertain to patients with acute myocardial infarction. Reported in-hospital mortality aft er cardiogenic shock form acute coronary syndrome is close to 60%. Identifying and classifying circulatory shock continues to be crucial in managing patients with shock. Monitoring hemodynamics, fl uid responsiveness, cardiac output, and lactate levels in order to guide fl uid therapy and the use of vasoactive drugs is the basis of managing circulatory shock. Th e microcirculatory profi le in circulatory shock is able to diff erentiate between survivors and non survivors when hemodynamic data failed to do so. Th e objective of managing and treating shock is to maintain tissue and organ perfusion by using fl uids, vasopressors, inotropes and sometimes vasodilators. However, choosing one or a combination of interventions is not always straightforward. Fluid administration is oft en the fi rst line of defense for hypotension in shock, with the underlying assumption of decreased preload. Although fl uid administration is appropriate in early stages of most types of shock, guidance is required as positive fl uid balance accumulates. Fluid accumulation that redistributes to the interstitial tissues rather than remaining in the intravascular space may increase the required perfusion pressure by increasing resistance through elevated tissue or organ pressure. Cardiac function can be best monitored by echocardiography, which aids in characterizing the nature of shock, selecting the appropriate intervention, and evaluating the patient's response to the intervention. For most intensivists, echocardiography is relatively easy to learn and perform at the bedside. Visual evaluation enables relatively precise estimation of the ejection fraction and left ventricular fi lling pressures. Echocardiography also provides dynamic variables for estimation of fl uid responsiveness and right ventricular function.