Point-of-Care Echocardiography and Hemodynamic Monitoring in Cirrhosis and Acute-on-Chronic Liver Failure in the COVID-19 Era.
Madhumita PremkumarKamal KajalAnand V KulkarniAnkur GuptaSmita DivyaveerPublished in: Journal of intensive care medicine (2021)
Point-of-Care (POC) transthoracic echocardiography (TTE) is transforming the management of patients with cirrhosis presenting with septic shock, acute kidney injury, hepatorenal syndrome and acute-on-chronic liver failure (ACLF) by correctly assessing the hemodynamic and volume status at the bedside using combined echocardiography and POC ultrasound (POCUS). When POC TTE is performed by the hepatologist or intensivist in the intensive care unit (ICU), and interpreted remotely by a cardiologist, it can rule out cardiovascular conditions that may be contributing to undifferentiated shock, such as diastolic dysfunction, myocardial infarction, myocarditis, regional wall motion abnormalities and pulmonary embolism. The COVID-19 pandemic has led to a delay in seeking medical treatment, reduced invasive interventions and deferment in referrals leading to "collateral damage" in critically ill patients with liver disease. Thus, the use of telemedicine in the ICU (Tele-ICU) has integrated cardiology, intensive care, and hepatology practices across the spectrum of ICU, operating room, and transplant healthcare. Telecardiology tools have improved bedside diagnosis when introduced as part of COVID-19 care by remote supervision and interpretation of POCUS and echocardiographic data. In this review, we present the contemporary approach of using POC echocardiography and offer a practical guide for primary care hepatologists and gastroenterologists for cardiac assessment in critically ill patients with cirrhosis and ACLF. Evidenced based use of Tele-ICU can prevent delay in cardiac diagnosis, optimize safe use of expert resources and ensure timely care in the setting of critically ill cirrhosis, ACLF and liver transplantation in the COVID-19 era.
Keyphrases
- liver failure
- left ventricular
- healthcare
- intensive care unit
- pulmonary embolism
- coronavirus disease
- hepatitis b virus
- primary care
- sars cov
- mechanical ventilation
- acute kidney injury
- heart failure
- pulmonary hypertension
- septic shock
- left atrial
- mitral valve
- palliative care
- computed tomography
- cardiac surgery
- oxidative stress
- magnetic resonance imaging
- inferior vena cava
- quality improvement
- acute respiratory distress syndrome
- pain management
- drug induced
- deep learning
- mass spectrometry
- respiratory syndrome coronavirus
- health insurance
- extracorporeal membrane oxygenation
- clinical evaluation