Septic shock is one of the most complex hemodynamic failure syndromes,
and its mode of expression is highly variable and may include each one to a variable
degree: absolute or relative reduction of volemia, severe peripheral vasodilatation, right
and left ventricular (RV and LV) myocardial failure and global myocardial
dysfunction. Because of this variability and to optimize the treatment, it seems
necessary to perform echocardiography at admission in intensive care unit (ICU) for
septic shock and repeat it at least once a day or more in case of hemodynamic
instability.
Echocardiographic findings should be integrated with clinical data and other
monitoring information, especially with those related to peripheral tissue perfusion.
Transesophageal echography (TEE) enables for a complete assessment, also detailing
heart-lung interactions and fine volume responsiveness evaluation but TEE is not
necessarily required if the transthoracic echography (TTE) provided answers to
questions.
Echocardiography allows help intensivists to establish therapeutic such as inotropes,
vasopressors or to optimize volemia after volume expansion. Thus, echocardiography is
now an unavoidable tool in assessing hemodynamic instability in septic shock patients.
A1ccordingly, echocardiography training is crucial to help its widespread use in all
ICUs.
Keywords: Echocardiography, Inotropes, Myocardial dysfunction, Right and left
ventricular dysfunction, Septic shock, Tissue Doppler, Volemia.
