Volume-Responsiveness Guided Hemodynamic Resuscitation with Passive Leg Raise by a Swan-Ganz Catheter and Point-Of-Care Echocardiogram in a Case of Mixed Shock
Erick Josué L M de Oca, Felipe de J Montelongo, Alan AR Ortega, Mauricio R Vera, Luis E S Medina, Josafat J G de la Cruz, Margarito C Meza, Jonathan G Ayala, Alfonso A S Mendoza, Aurea C Domínguez, Carlos G B Flores, Roberto F Suárez, German N Beltrán, Nicolás H Reyes.
Literature does not report hemodynamic monitoring through the Swan-Ganz catheter as a dynamic variable to evaluate the response to volume. Furthermore, it does not compare it with a point-of-care echocardiogram as an alternative non-invasive monitoring method. Therefore, we present the case of a 64-year-old man admitted to the Intensive Care Unit in shock, clinically associated with sepsis with a source of infection at the pulmonary level. However, during his stay in the Unit, invasive monitoring was performed with a thermodilution catheter in the pulmonary artery, as well as an echocardiogram monitoring which showed the presence of severe myocardial dysfunction in a hyperdynamic state. Resuscitation was initiated by measuring cardiac output by thermodilution and ultrasonography. This dynamic helped to assess the volume responsiveness by raising the leg passively, which showed that the patient was non-responsive. Management was focused on serial monitoring and use of an inotropic drug, presenting a marked clinical improvement until the resolution of the pathological state and the subsequent release from intensive care due to the patient’s condition improves.View pdf