The monitoring of hemodynamic parameters is an important tool for the diagnosis of different kinds of shock, as well as the management of such cases. The table below shows the main hemodynamic characteristics of different kinds of shock:
| Type of Shock | PWP | CO | SVR | ScVO2 /sVO2 | CVP |
|---|---|---|---|---|---|
| Hypovolemic | ↓ | ↓ | ↑ | ↑ (early) or ↓ (late) | ↓ |
| Cardiogenic | ↑ | ↓ | ↑ | ↓ | ↑ |
| Distributive | |||||
| - Neurogenic | ↓ | ↓ | ↓ | ↓ | ↓ |
| - Anaphylactic | ↓ | ↓ | ↓ | ↓ | ↓ |
| - Septic | ↓ | ↑ or ↓ | ↓ | ↑ | ↓ |
| Obstructive | |||||
| - Pulmonary embolism, tension pneumothorax | ↓ | ↓ | ↑ | ↑ | ↑ |
| - Pericardial tamponade | ↑ | ↓ | ↑ | ↓ | ↑ |
PWP – Pulmonary Artery Wedge Pressure (Preload)
CO – Cardiac Output
CVP – Central Venous Pressure
SVR – Systemic vascular resistance (Afterload)
SvO2 – Mixed Venous Oxygen Saturation (From Pulmonary Artery Catheter). Cutoff is 65%.
ScvO2 – Central venous O2 saturation (From Regular Central Line). Cutoff is 70%.
REFERENCES & FURTHER READING:
- Circulatory Shock. Jean-Louis Vincent, M.D., Ph.D., and Daniel De Backer, M.D., Ph.D. N Engl J Med 2013; 369:1726-1734
- Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension. Jones AE, Craddock PA, Tayal VS, Kline JA. Shock 2005; 24:513.
- Hemodynamic parameters to guide fluid therapy. Paul E Marik et al. Ann Intensive Care. 2011; 1: 1.
- Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Joe Brierley et al. Crit Care Med. 2009 Feb; 37(2): 666–688.