ICU Cases · Haemodynamic monitoring
Short case — interpreting the haemodynamic profile of shock
A focused CICM short case on reading a haemodynamic profile to classify shock — the Forrester-quadrant skill. The candidate reads a low cardiac output, a high wedge pressure, a high systemic vascular resistance and a low venous saturation, recognises cardiogenic shock (pump failure on the right of the Starling curve), and states that the management is inotropy, diuresis and source — not fluid — distinguishing it from the distributive and hypovolaemic profiles.
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Prompt
You are shown the haemodynamic profile of a 70-year-old man in shock, measured by a pulmonary artery catheter and an arterial line. Cardiac index 1.9 L/min/m², pulmonary artery occlusion pressure 26 mmHg, systemic vascular resistance 1900 dyn·s·cm⁻⁵, mixed venous oxygen saturation 58%. Classify the shock, interpret each variable, and state your immediate management priorities.
Presentation
You are shown the haemodynamic profile of a 70-year-old man in shock:
| Variable | Value | Normal range |
|---|---|---|
| Cardiac index | 1.9 L/min/m² | 2.5–4.0 |
| Pulmonary artery occlusion pressure | 26 mmHg | 6–12 |
| Systemic vascular resistance | 1900 dyn·s·cm⁻⁵ | 800–1200 |
| Mixed venous oxygen saturation | 58% | 65–75 |
| Mean arterial pressure | 64 mmHg | 70–95 |
| Lactate | 3.8 mmol/L | 0.5–2.0 |
Classify the shock, interpret each variable, and state your immediate management priorities.[1]
References2ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.