Skip to main content
Top
Published in: The Ultrasound Journal 3/2011

Open Access 01-12-2011 | Original Article

EGLS: Echo-guided life support

An algorithmic approach to undifferentiated shock

Authors: Jean-François Lanctôt, Maxime Valois, Yanick Beaulieu

Published in: The Ultrasound Journal | Issue 3/2011

Login to get access

Abstract

Introduction

The primary challenge in the initial assessment of a patient with undifferentiated shock is to quickly identify and treat any reversible causes of shock. Bedside ultrasound provides real-time information that can assist with the achievement of this goal; as a result, it has gained widespread popularity in the field of critical care and emergency medicine. Many researchers have suggested that the use of a simple ultrasound approach to guide the management of these patients would reduce the morbidity associated with delayed or inappropriate treatment and would result in better outcomes.

Purpose

With the goal of optimizing early management of critically ill patients, we describe in this article an algorithm based on simple clinical questions that combines the information provided by lung, cardiac and inferior vena cava ultrasonography.

Conclusions

The advantages of this approach, in addition to efficiency, include easy reproducibility and standardization for teaching purposes and clinical trials.
Literature
1.
go back to reference Kaul S, Stratienko AA, Pollock SG, Marieb MA, Keller MW, Sabia PJ (1994) Value of two-dimensional echocardiography for determining the basis of hemodynamic compromise in critically ill patients: a prospective study. J Am Soc Echocardiogr: Off publication Am Soc Echocardiogr 7(6):598–606CrossRef Kaul S, Stratienko AA, Pollock SG, Marieb MA, Keller MW, Sabia PJ (1994) Value of two-dimensional echocardiography for determining the basis of hemodynamic compromise in critically ill patients: a prospective study. J Am Soc Echocardiogr: Off publication Am Soc Echocardiogr 7(6):598–606CrossRef
3.
go back to reference Tayal VS, Kline JA (2003) Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states. Resuscitation 59(3):315–318PubMedCrossRef Tayal VS, Kline JA (2003) Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states. Resuscitation 59(3):315–318PubMedCrossRef
4.
go back to reference Jones AE, Tayal VS, Sullivan DM, Kline JA (2004) Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med 32(8):1703–1708PubMedCrossRef Jones AE, Tayal VS, Sullivan DM, Kline JA (2004) Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med 32(8):1703–1708PubMedCrossRef
6.
go back to reference Testa A, Cibinel GA, Portale G, Forte P, Giannuzzi R, Pignataro G, Silveri NG (2010) The proposal of an integrated ultrasonographic approach into the ALS algorithm for cardiac arrest: the PEA protocol. Eur Review Med Pharmacol Sci 14(2):77–88 Testa A, Cibinel GA, Portale G, Forte P, Giannuzzi R, Pignataro G, Silveri NG (2010) The proposal of an integrated ultrasonographic approach into the ALS algorithm for cardiac arrest: the PEA protocol. Eur Review Med Pharmacol Sci 14(2):77–88
7.
8.
go back to reference Bahner D (2002) Trinity: a hypotensive ultrasound protocol journal of diagnostic medical sonography. J Diagn Med Sonogr 18:193–198CrossRef Bahner D (2002) Trinity: a hypotensive ultrasound protocol journal of diagnostic medical sonography. J Diagn Med Sonogr 18:193–198CrossRef
10.
go back to reference Jensen MB, Sloth E, Larsen KM, Schmidt MB (2004) Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol 21(9):700–707PubMedCrossRef Jensen MB, Sloth E, Larsen KM, Schmidt MB (2004) Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol 21(9):700–707PubMedCrossRef
12.
go back to reference Blaivas M, Lyon M, Duggal S (2005) A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med: Off J Soc Acad Emerg Med 12(9):844–849. doi:10.1197/j.aem.2005.05.005CrossRef Blaivas M, Lyon M, Duggal S (2005) A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med: Off J Soc Acad Emerg Med 12(9):844–849. doi:10.​1197/​j.​aem.​2005.​05.​005CrossRef
13.
go back to reference Dulchavsky SA, Schwarz KL, Kirkpatrick AW, Billica RD, Williams DR, Diebel LN, Campbell MR, Sargysan AE, Hamilton DR (2001) Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma 50(2):201–205PubMedCrossRef Dulchavsky SA, Schwarz KL, Kirkpatrick AW, Billica RD, Williams DR, Diebel LN, Campbell MR, Sargysan AE, Hamilton DR (2001) Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma 50(2):201–205PubMedCrossRef
14.
go back to reference Lichtenstein DA, Menu Y (1995) A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest 108(5):1345–1348PubMedCrossRef Lichtenstein DA, Menu Y (1995) A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest 108(5):1345–1348PubMedCrossRef
15.
go back to reference Lichtenstein DA, Meziere G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M (2005) Ultrasound diagnosis of occult pneumothorax. Crit Care Med 33(6):1231–1238PubMedCrossRef Lichtenstein DA, Meziere G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M (2005) Ultrasound diagnosis of occult pneumothorax. Crit Care Med 33(6):1231–1238PubMedCrossRef
16.
go back to reference Lichtenstein D, Meziere G, Biderman P, Gepner A (2000) The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med 26(10):1434–1440PubMedCrossRef Lichtenstein D, Meziere G, Biderman P, Gepner A (2000) The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med 26(10):1434–1440PubMedCrossRef
17.
go back to reference Lichtenstein D, Meziere G, Biderman P, Gepner A, Barre O (1997) The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 156(5):1640–1646PubMedCrossRef Lichtenstein D, Meziere G, Biderman P, Gepner A, Barre O (1997) The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 156(5):1640–1646PubMedCrossRef
18.
go back to reference Lichtenstein D, Meziere G (1998) A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med 24(12):1331–1334PubMedCrossRef Lichtenstein D, Meziere G (1998) A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med 24(12):1331–1334PubMedCrossRef
20.
go back to reference Lichtenstein DA, Meziere GA, Lagoueyte JF, Biderman P, Goldstein I, Gepner A (2009) A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill. Chest 136(4):1014–1020. doi:10.1378/chest.09-0001PubMedCrossRef Lichtenstein DA, Meziere GA, Lagoueyte JF, Biderman P, Goldstein I, Gepner A (2009) A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill. Chest 136(4):1014–1020. doi:10.​1378/​chest.​09-0001PubMedCrossRef
21.
go back to reference Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, Picano E (2005) “Ultrasound comet-tail images”: a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest 127(5):1690–1695. doi:10.1378/chest.127.5.1690PubMedCrossRef Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, Picano E (2005) “Ultrasound comet-tail images”: a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest 127(5):1690–1695. doi:10.​1378/​chest.​127.​5.​1690PubMedCrossRef
22.
go back to reference Liteplo AS, Marill KA, Villen T, Miller RM, Murray AF, Croft PE, Capp R, Noble VE (2009) Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med: Off J Soc Acad Emerg Med 16(3):201–210. doi:10.1111/j.1553-2712.2008.00347.xCrossRef Liteplo AS, Marill KA, Villen T, Miller RM, Murray AF, Croft PE, Capp R, Noble VE (2009) Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med: Off J Soc Acad Emerg Med 16(3):201–210. doi:10.​1111/​j.​1553-2712.​2008.​00347.​xCrossRef
23.
go back to reference Lichtenstein D, Meziere G, Biderman P, Gepner A (1999) The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 25(4):383–388PubMedCrossRef Lichtenstein D, Meziere G, Biderman P, Gepner A (1999) The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 25(4):383–388PubMedCrossRef
26.
go back to reference Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA (2002) Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med: Off J Soc Acad Emerg Med 9(3):186–193CrossRef Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA (2002) Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med: Off J Soc Acad Emerg Med 9(3):186–193CrossRef
27.
go back to reference Randazzo MR, Snoey ER, Levitt MA, Binder K (2003) Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med: Off J Soc Acad Emerg Med 10(9):973–977CrossRef Randazzo MR, Snoey ER, Levitt MA, Binder K (2003) Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med: Off J Soc Acad Emerg Med 10(9):973–977CrossRef
30.
go back to reference Hope MD, de la Pena E, Yang PC, Liang DH, McConnell MV, Rosenthal DN (2003) A visual approach for the accurate determination of echocardiographic left ventricular ejection fraction by medical students. J Am Soc Echocardiogr: Off Publ Am Soc Echocardiogr 16(8):824–831. doi:10.1067/S0894-7317(03)00400-0CrossRef Hope MD, de la Pena E, Yang PC, Liang DH, McConnell MV, Rosenthal DN (2003) A visual approach for the accurate determination of echocardiographic left ventricular ejection fraction by medical students. J Am Soc Echocardiogr: Off Publ Am Soc Echocardiogr 16(8):824–831. doi:10.​1067/​S0894-7317(03)00400-0CrossRef
31.
go back to reference Armstrong WF, Schilt BF, Helper DJ, Dillon JC, Feigenbaum H (1982) Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study. Circulation 65(7):1491–1496PubMedCrossRef Armstrong WF, Schilt BF, Helper DJ, Dillon JC, Feigenbaum H (1982) Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study. Circulation 65(7):1491–1496PubMedCrossRef
32.
go back to reference Gillam LD, Guyer DE, Gibson TC, King ME, Marshall JE, Weyman AE (1983) Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade. Circulation 68(2):294–301PubMedCrossRef Gillam LD, Guyer DE, Gibson TC, King ME, Marshall JE, Weyman AE (1983) Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade. Circulation 68(2):294–301PubMedCrossRef
33.
go back to reference Kircher BJ, Himelman RB, Schiller NB (1990) Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 66(4):493–496PubMedCrossRef Kircher BJ, Himelman RB, Schiller NB (1990) Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 66(4):493–496PubMedCrossRef
34.
go back to reference Yanagawa Y, Nishi K, Sakamoto T, Okada Y (2005) Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma 58(4):825–829PubMedCrossRef Yanagawa Y, Nishi K, Sakamoto T, Okada Y (2005) Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma 58(4):825–829PubMedCrossRef
36.
go back to reference Kitamura H, Kobayashi C (2005) Impairment of change in diameter of the hepatic portion of the inferior vena cava: a sonographic sign of liver fibrosis or cirrhosis. J Ultrasound Med: Off J Am Inst Ultrasound Med 24(3):355–359; quiz 360–351 Kitamura H, Kobayashi C (2005) Impairment of change in diameter of the hepatic portion of the inferior vena cava: a sonographic sign of liver fibrosis or cirrhosis. J Ultrasound Med: Off J Am Inst Ultrasound Med 24(3):355–359; quiz 360–351
38.
go back to reference Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome JL, Jardin F, Vieillard-Baron A (2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 30(9):1740–1746. doi:10.1007/s00134-004-2259-8PubMed Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome JL, Jardin F, Vieillard-Baron A (2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 30(9):1740–1746. doi:10.​1007/​s00134-004-2259-8PubMed
39.
go back to reference Jones AE, Craddock PA, Tayal VS, Kline JA (2005) Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension. Shock 24(6):513–517PubMedCrossRef Jones AE, Craddock PA, Tayal VS, Kline JA (2005) Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension. Shock 24(6):513–517PubMedCrossRef
40.
go back to reference Kasper W, Meinertz T, Kersting F, Lollgen H, Limbourg P, Just H (1980) Echocardiography in assessing acute pulmonary hypertension due to pulmonary embolism. Am J Cardiol 45(3):567–572PubMedCrossRef Kasper W, Meinertz T, Kersting F, Lollgen H, Limbourg P, Just H (1980) Echocardiography in assessing acute pulmonary hypertension due to pulmonary embolism. Am J Cardiol 45(3):567–572PubMedCrossRef
41.
go back to reference Jardin F, Dubourg O, Gueret P, Delorme G, Bourdarias JP (1987) Quantitative two-dimensional echocardiography in massive pulmonary embolism: emphasis on ventricular interdependence and leftward septal displacement. J Am Coll Cardiol 10(6):1201–1206PubMedCrossRef Jardin F, Dubourg O, Gueret P, Delorme G, Bourdarias JP (1987) Quantitative two-dimensional echocardiography in massive pulmonary embolism: emphasis on ventricular interdependence and leftward septal displacement. J Am Coll Cardiol 10(6):1201–1206PubMedCrossRef
43.
go back to reference Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, Maury E, Slama M, Vignon P (2009) American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest 135(4):1050–1060. doi:10.1378/chest.08-2305PubMedCrossRef Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, Maury E, Slama M, Vignon P (2009) American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest 135(4):1050–1060. doi:10.​1378/​chest.​08-2305PubMedCrossRef
44.
go back to reference Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K (2010) Focused cardiac ultrasound in the emergent setting: a consensus statement of the american society of echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr: Off Publ Am Soc Echocardiogr 23(12):1225–1230. doi:10.1016/j.echo.2010.10.005CrossRef Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K (2010) Focused cardiac ultrasound in the emergent setting: a consensus statement of the american society of echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr: Off Publ Am Soc Echocardiogr 23(12):1225–1230. doi:10.​1016/​j.​echo.​2010.​10.​005CrossRef
45.
go back to reference Price S, Via G, Sloth E, Guarracino F, Breitkreutz R, Catena E, Talmor D (2008) Echocardiography practice, training and accreditation in the intensive care: document for the world interactive network focused on critical ultrasound (WINFOCUS). Cardiovasc Ultrasound 6:49. doi:10.1186/1476-7120-6-49PubMedPubMedCentralCrossRef Price S, Via G, Sloth E, Guarracino F, Breitkreutz R, Catena E, Talmor D (2008) Echocardiography practice, training and accreditation in the intensive care: document for the world interactive network focused on critical ultrasound (WINFOCUS). Cardiovasc Ultrasound 6:49. doi:10.​1186/​1476-7120-6-49PubMedPubMedCentralCrossRef
Metadata
Title
EGLS: Echo-guided life support
An algorithmic approach to undifferentiated shock
Authors
Jean-François Lanctôt
Maxime Valois
Yanick Beaulieu
Publication date
01-12-2011
Publisher
Springer Milan
Published in
The Ultrasound Journal / Issue 3/2011
Electronic ISSN: 2524-8987
DOI
https://doi.org/10.1007/s13089-011-0083-2

Other articles of this Issue 3/2011

The Ultrasound Journal 3/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.