Table 1.

Therapeutic algorithm according to the results of basic CCE performed for acute circulatory and/or respiratory failure

Echocardiographic parameters and derived therapeutic proposals	Hypovolemia	LV systolic dysfunction	RV dysfunction (± acute cor pulmonale)	Tamponade	Acute massive MR or AR	Vasoplegia
LV systolic function	N or ↑	↓ to ↓↓	N	N	N to ↑	↑ to ↑↑
LV size	↓ to ↓↓	N or ↑ to ↑↑a	N or ↓	N or ↓	N	N or ↓ (± end-systolic obliteration)
RV size	↓ to ↓↓	N	↑ to ↑↑b (± paradoxical septal motion)	↓ to ↓↓	N	N
Pericardial effusion	–	–	–	+ to +++	–	–
Maximal IVC diameter/respiratory variation of IVC size in spontaneously breathing patients	< 12 mm/total inspiratory collapse	–	> 23 mm/little or no respiratory variation	> 23 mm/no respiratory variation	–	–
Color Doppler mapping	–	–	–	–	Massive regurgitation	–
Therapeutic proposals	Fluid loading	Inotropesc	Vasopressord ± protective ventilation ± prone ventilation ± inhaled nitric oxide	Pericardiocentesis	Emergency valve surgery	Vasopressor support

CCE critical care echocardiography, LV left ventricle, RV right ventricle, IVC inferior vena cava, N normal, MR mitral regurgitation, AR aortic regurgitation

^aA visually dilated left atrium together with a constant bulging of the interatrial septum towards the right atrium throughout the cardiac and respiratory cycle was consistent with elevated left ventricular filling pressures

^bA visually dilated right atrium together with a constant bulging of the interatrial septum towards the left atrium throughout the cardiac and respiratory cycle was consistent with elevated right ventricular filling pressures, hence systemic venous congestion

^cDiuretics could be proposed to reduce fluid balance in hemodynamically stable patients with respiratory compromise

^dInotropes may be discussed in the presence of severe biventricular systolic dysfunction