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Management of cardiovascular insufficiency in ICU: the BEAT approach

Fabio Guarracino1, Pietro Bertini2, Michael R Pinsky3

  • 1Unit of Cardiothoracic, Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Pisa, Italy - fabiodoc64@hotmail.com.

Minerva Anestesiologica
|August 6, 2020
PubMed

Insights

Managing hemodynamic instability in ICU patients requires prompt assessment. The BEAT approach, combining echocardiography and functional hemodynamic monitoring, personalizes treatment for better outcomes.

Area of Science:

  • Critical Care Medicine
  • Cardiovascular Physiology
  • Point-of-Care Ultrasound

Background:

  • Hemodynamic deterioration is common in ICU patients, leading to increased mortality if not managed promptly.
  • Clinical signs like altered consciousness and skin mottling indicate hypoperfusion and necessitate urgent evaluation.
  • Serum lactate is a marker of hypoperfusion but lacks specificity for its cause.

Purpose of the Study:

  • To introduce a structured, step-by-step approach for managing acute hemodynamic instability in ICU patients.
  • To highlight the integration of bedside echocardiography and functional hemodynamic monitoring for personalized care.

Main Methods:

  • The proposed approach, termed BEAT (Browse the heart, Measure elastances, Assess volume status, Treat), involves rapid ultrasound assessment of cardiac function.
  • It emphasizes understanding heart-circulation interactions and utilizing functional hemodynamic monitoring (FHM).
  • Combines echocardiography with FHM for comprehensive hemodynamic assessment.

Main Results:

  • The BEAT approach provides a systematic method for evaluating hemodynamic instability.
  • Integrating echocardiography and FHM allows for a detailed assessment of cardiac function and volume status.
  • This integrated method facilitates personalized hemodynamic management strategies.

Conclusions:

  • The BEAT approach offers a novel, integrated strategy for managing ICU hemodynamic instability.
  • Combining echocardiography and FHM enables personalized and effective hemodynamic resuscitation.
  • Prompt and accurate hemodynamic assessment is crucial for improving patient outcomes in the ICU.

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