Table 1 Patients’ characteristics of the case series to whom our algorithm based on VTI was performed
Patient | Clinical scenario | VTI and others TTE parameters | Cause of hemodynamic shock | Therapeutic strategy |
|---|---|---|---|---|
1 | - Anesthesia induction for cholecystectomy due to acute cholecystitis -IHD with LVEF 25% | - LVOT VTI 19 cm - IVC of 20 mm and distensibility of 10% - Mitral-inflow E/A ratio 1.2 | - Distributive Shock secondary to anesthetic drugs | Vasopressors (phenylephrine or noradrenaline) |
2 | - Postoperative of an arteriovenous peripheral abscess drainage complicated with bleeding requiring polytransfusion - CKD on IHD - Previous PE. IHD | - LVOT VTI 21 cm - Fluid responsive - IVC diameter 15 mm and distensibility of 20% | - Distributive shock secondary to either SIRS or Sepsis 2ry to the abscess. Along with, being fluid responsive with signs of tissular hypoperfusion | Fluid therapy first followed by vasopressors |
3 | - Postoperative of a diffuse secondary peritonitis secondary to perforated duodenal ulcer complicated with bleeding -No past medical history | - LVOT VTI 14 cm - IVC was 22 mm and distensibility was 5% - Mitral-inflow E/A ratio 1.9 | - Mixed Shock (distributive plus cardiogenic) due to a stress cardiomyopathy | Dobutamine infusion and diuretics |
4 | - Postoperative of a diffuse secondary peritonitis 2ry to a perforated ascending colon due to a cancer requiring a right colectomy complicated with severe bleeding - Hypertension - Diabetes - IHD with preserved LVEF | - LVOT VTI 16 cm - IVC 8 mm with a distensibility of 20% - Mitral E/A ratio 0,9 - Fluid responsive with a 15% increase in LVOT VTI after a PLRT | - Hypovolemic shock due to severe bleeding during surgery with signs of tissular hypoperfusion | - Fluid therapy - Maintain or decrease vasopressors if possible |