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Monitorizarea hemodinamică miniinvazivă cu pulsul contur debitului cardiac în infarctul miocardic acut complicat cu șoc cardiogen: caz clinic

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dc.contributor.author Gîrbu, Lucia
dc.date.accessioned 2020-05-26T11:09:12Z
dc.date.available 2020-05-26T11:09:12Z
dc.date.issued 2018
dc.identifier.citation GÎRBU, Lucia. Minimally invasive hemodynamic monitoring pulse contour cardiac output in acute myocardial infarction complicated with cardiogenic shock, clinical case = Monitorizarea hemodinamică miniinvazivă cu pulsul contur debitului cardiac în infarctul miocardic acut complicat cu șoc cardiogen: caz clinic. In: The Moldovan Medical Journal. 2018, vol. 61, AIC Congress Issue, september, p. 31. ISSN 2537-6381. en_US
dc.identifier.issn 2537-6381
dc.identifier.uri http://moldmedjournal.md/wp-content/uploads/2018/09/61-4-ATI-Congres.pdf
dc.identifier.uri http://repository.usmf.md/handle/20.500.12710/9846
dc.description Secţia de terapie intensivă, Spitalul Clinic Municipal “Sfânta Treime”, Chișinău, Republica Moldova, The 5th International Congress of the Society of Anesthesiology and Reanimatology of the Republic of Moldova, 16th Edition of the International Course of Guidelines and Protocols in Anesthesia, Intensive Care and Emergency Medicine, 28th Meeting of the European Society for Computing and Technology in Anesthesia and Intensive Care September 27-29, 2018, Chisinau, the Republic of Moldova en_US
dc.description.abstract Introducere: Şocul cardiogen (ŞC) este o urgență cu o rată a mortalităţii înaltă, cuprinsă între 40-80%, fapt ce impune necesitatea monitorizării hemodinamice invazive și selectarea tratamentului adecvat precoce. Material și metode: Analiza prospectivă a cazului pacientului spitalizat în secția de terapie intensivă cu infarct miocardic acut complicat cu șoc cardiogen, evaluat prin PiCCO și tratat cu vasopresori, inovasodilatatori și antiaritmice. Descrierea cazului clinic: Pacienta L, 68 ani, internată în secţia de terapie intensivă cu infarct miocardic acut, complicat cu șoc cardiogen, tahicaradie ventriculară, IC IV KILLIP cu scor APACHE II 23p r.m. 46%. La internare TAM 60mmHg, FCC 67b/min, parametrii monitorului Pulse Contour Cardiac Output (PiCCO): indexul rezistenței vasculare sistemice (SVRI) 3268 dyn.sec.m2/cm5, indexul cardiac (PCIC) 1,96 L/min/ m2, debitul cardiac (DC) 3,2l, volum bătaie indexat (SVI) 30 ml, volumul telediastolic global indexat (GEDI) 620 ml/m2, fracția de ejecție globală (GEF) 22%, lichidul extravascular pulmonar indexat (ELWI) 8ml/kg, fracția de ejecție a VS (FE) 36%, proBNP 300pg/nl, lactat 4,4mmol/l. După monitorizare cu PiCCO, cardioversie electrică, administrare de vasopresori și inovasodilatatori (Levosimendan) și antiaritmice s-a înregistrat dinamică pozitivă clinic, auscultativ, radiologic și ecocardiografic, cu TAM 98mmHg, FCC 83b/min, proBNP 98pg/nl, SVRI 1627 dyn. sec.m2/cm5, PCIC 3,48L/min/m2, DC 6,2 L/min, SVI 46 ml, GEDI 840 ml/m2, GEF 35%, ELWI 5ml/kg, FE 45%, lactatul seric 1.2mmol/l. Concluzii: O nouă alternativă de monitorizare hemodinamică în șocul cardiogen o prezintă aparatul PiCCO, care determină parametrii volumetrici și ai debitului cardiac, permite administrarea corectă a tratamentului cu vasopresori, inovasodilatatori, a volumului infuzional, conduce la creşterea indexului cardiac, FE, corecției lichidului extravascular pulmonar ce influențează pozitiv pronosticul.
dc.description.abstract Background: Cardiogenic shock (CS) is an emergency with a high mortality of 40-80%, which highlights the need for invasive hemodynamic monitoring and selection of an early appropriate treatment. Material and methods: A prospective analysis of clinical case with the patient hospitalized in ICU with AMI, complicated with CS evaluated by PiCCO and treated with vasopressors, inovasodilators and antiarrhythmics. Clinical case description: Patient L, 68 years old, TI hospitalized with AMI complicated with the CS and, IC IV KILLIP, APACHE score: 15p rm 24%, TAM 60 mmHg, Pulse Contour Cardiac Output (PICCO) monitor parameters: at hospitalization TAM 60 mmHg, FCC 67 b/min, Pulse Contour Cardiac Output (PiCCO) monitor parameters: Systemic Vascular Resistance Index (SVRI) 3268 dyn.sec.m2/cm5, cardiac index (CI) 1.96 L/min/m2, cardiac output (DC) 3.2 l, stroke volume index (SVI) 30 ml, Global End-Diastolic Volume Index (GEDI) 620 ml/m 2, global ejection fraction (GEF) is 22%; Extravascular Lung Water Index (EVLWI) 8ml/kg, ejection fraction (EF) of LV is 36%, pro BNP 300pg/ml, lactate4.4 mmol/l. After monitoring with PICCO, electrical cardioversion, administration of vasopressors and inovasodilators (Levosimendan), antiarrhythmic, clinical, auscultatory, radiological and echocardiographic positive dynamics were recorded, with TAM 98 mmHg, FCC 83 b/ min, proBNP 98 pg/ml, SVRI 1627 dyn.sec.m2 cm5, PCIC 3.48 L/min/m2, DC 6.2 L/min, SVI 46 ml, GEDI 840 ml/m2, GEF 35%, ELWI 5 ml/kg, EF 45%, serum lactate 1.2 mmol/l. Conclusions: A new monitoring alternative in CS is represented by the PICCO device which provides volumetric and cardiac flow parameters, correct administration of adrenomimetic and infusion volume therapy leads to increased PCIC and EF, correction of the ELWI and positively influences the prognosis.
dc.language.iso ro en_US
dc.publisher The Scientific Medical Association of the Republic of Moldova en_US
dc.relation.ispartof The Moldovan Medical Journal: The 5th International Congress of the Society of Anesthesiology and Reanimatology of the Republic of Moldova, 16th Edition of the International Course of Guidelines and Protocols in Anesthesia, Intensive Care and Emergency Medicine, 28th Meeting of the European Society for Computing and Technology in Anesthesia and Intensive Care September 27-29, 2018, Chisinau, the Republic of Moldova
dc.subject cardiogenic shock en_US
dc.subject hemodynamic monitoring en_US
dc.subject PiCCO en_US
dc.title Monitorizarea hemodinamică miniinvazivă cu pulsul contur debitului cardiac în infarctul miocardic acut complicat cu șoc cardiogen: caz clinic en_US
dc.title.alternative Minimally invasive hemodynamic monitoring pulse contour cardiac output in acute myocardial infarction complicated with cardiogenic shock, clinical case
dc.type Article en_US


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  • The Moldovan Medical Journal, Vol. 61, September 2018 AIC Congress Issue
    The 5th International Congress of the Society of Anesthesiology and Reanimatology of the Republic of Moldova, 16th Edition of the International Course of Guidelines and Protocols in Anesthesia, Intensive Care and Emergency Medicine, 28th Meeting of the European Society for Computing and Technology in Anesthesia and Intensive Care September 27-29, 2018, Chisinau, the Republic of Moldova

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