EXPERTS’ OPINION   Free access

Minerva Anestesiologica 2021 April;87(4):476-80

DOI: 10.23736/S0375-9393.20.14613-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Management of cardiovascular insufficiency in ICU: the BEAT approach

Fabio GUARRACINO ¹ ✉, Pietro BERTINI ¹, Michael R. PINSKY ²

¹ Unit of Cardiothoracic, Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Pisa, Italy; ² Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA

A large number of patients admitted to ICU display hemodynamic deterioration at some time during their stay. The management of acute hemodynamic derangement of any cause can be difficult and has to be accomplished quickly and correctly as delayed and inappropriate resuscitation treatments carry increased mortality. Cardiovascular insufficiency shows end-organ hypoperfusion-associated dysfunction, thus decreasing level of consciousness, falling urine output, ileus, new onset tachypnea and the presence of skin mottling are important clinical clues to cardiovascular deterioration and should be promptly looked for and if detected alert the bedside clinician that further assessment and potentially treatment is necessary. Although measures of serum lactate are useful to document the presence of tissue hypoperfusion, they are non-specific in defining its etiology. In a patient with acute hemodynamic instability, we propose a step-by-step approach as follows: 1) rapid initial ultrasound assessment of heart function; 2) pathophysiological understanding of heart and circulation interaction; 3) functional hemodynamic monitoring; and 4) treatment. We named such approach BEAT, which stands for: browse the heart, measure the elastances, assess volume status, and treat. Combining bedside echocardiography, including the evaluation of the interaction between the heart and the circulation, with FHM offers the opportunity to personalize the hemodynamic management to the specific requirements.

KEY WORDS: Hemodynamic monitoring; Echocardiography; Critical Care