Haemodynamic instability

Chapter 21 brings together many topics that are covered in earlier chapters, notably Chapter 3: Quantitative echocardiography. The chapter is divided into two sections. In the first section, methods for assessing the haemodynamic state are covered, including the measurement of stroke volume, cardiac output, LA pressure, pulmonary artery pressure, preload, and volume responsiveness. The focus of this section is on techniques that are directly applicable to TOE in mechanically ventilated patients. In the second section, the causes of haemodynamic instability are reviewed. Topics include hypovolaemia, low LV afterload, LV systolic dysfunction, LV diastolic dysfunction, RV systolic dysfunction, and cardiac tamponade. An integrated approach to the difficult diagnosis is also provided.