Utilidad clínica de la ultrasonografía en el punto de atención en el paciente con shock: Una revisión narrativa
Barra lateral del artículo
Detalles del artículo
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
La publicación se distribuye bajo la Licencia Creative Commons Atribución- 4.0 Internacional (CC BY 4.0). Los derechos de los trabajos publicados en esta revista son propiedad del autor, los cuales son libres de distribuir y difundir las mismas, siempre que cite correctamente la fuente.
Contenido principal del artículo
Resumen
El shock, una emergencia médica caracterizada por perfusión inadecuada y disfunción orgánica, puede clasificarse en distributivo, hipovolémico, cardiogénico y obstructivo. La ecografía en el punto de atención (POCUS, por sus siglas en inglés) se ha consolidado como una herramienta fundamental en el diagnóstico diferencial y la guía terapéutica en pacientes con shock. Este artículo revisa la utilidad clínica del POCUS, destacando su alta precisión diagnóstica en diferenciar los tipos de shock, con sensibilidades y especificidades superiores al 90% en escenarios como shock hipovolémico y obstructivo. Además, el uso del POCUS ha demostrado mejorar la precisión diagnóstica en urgencias, optimizar la reanimación hídrica y reducir la mortalidad en pacientes críticos. Su implementación fortalece la toma de decisiones clínicas, integrando un enfoque diagnóstico rápido y efectivo que favorece la gestión interdisciplinaria para prevenir insuficiencia multiorgánica y muerte.
Citas
Alyeşil, C., Doğan, N. Ö., Özturan, İ. U., & Güney, S. (2017). Distributive Shock in the Emergency Department: Sepsis, Anaphylaxis, or Capillary Leak Syndrome? Journal of Emergency Medicine, 52(6), e229-e231. https://doi.org/10.1016/j.jemermed.2017.01.012.
Berg, I., Walpot, K., Lamprecht, H., Valois, M., Lanctôt, J.-F., Srour, N., & van den Brand, C. (2022). A Systemic Review on the Diagnostic Accuracy of Point-of-Care Ultrasound in Patients With Undifferentiated Shock in the Emergency Department. Cureus, 14(3). https://doi.org/10.7759/cureus.23188.
Böcklein, M., Beck, M., & Shmygalev, S. (2023). Distributive shock. Anaesthesiologie, 72(8), 608-618. https://doi.org/10.1007/s00101-023-01304-1.
Chawla, L. S., Busse, L. W., Brasha-Mitchell, E., & Alotaibi, Z. (2016). The use of angiotensin II in distributive shock. Critical Care, 20(1), 27230465. https://doi.org/10.1186/s13054-016-1306-5.
Curcio, L., D’Orsi, L., & De Gaetano, A. (2021). Seven Mathematical Models of Hemorrhagic Shock. Computational and Mathematical Methods in Medicine, 2021, 1-2. https://doi.org/10.1155/2021/6640638.
Elbers, P. W. G., & Ince, C. (2006). Bench-to-bedside review: Mechanisms of critical illness - Classifying microcirculatory flow abnormalities in distributive shock. Critical Care, 10(4), 1-2. https://doi.org/10.1186/cc4969.
Evora, P. R. B. (2013). Methylene Blue Does Not Have to Be Considered Only as Rescue Therapy for Distributive Shock. Journal of Medical Toxicology, 9(4), 426. https://doi.org/10.1007/s13181-013-0333-8.
Feng, M., McSparron, J. I., Kien, D. T., Stone, D. J., Roberts, D. H., Schwartzstein, R. M., VieillardBaron, A., & Celi, L. A. (2018). Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database. Intensive Care Medicine, 44(6), 884-892. https://doi.org/10.1007/s00134-018-5208-7.
Furukawa, S., Inanaga, K., Osaki, T., Yasuda, M., Ohga, Y., Ohishi, Y., Matsumoto, T., Uchida, T., & Inoue, S. (2024). Obstructive Shock Due to a Crushed Left Atrium and Pulmonary Vein by Pulmonary Artery Intimal Sarcoma Successfully Treated with Pulmonary Vein Stenting. Internal Medicine, 63(2), 247-252. https://doi.org/10.2169/internalmedicine.1487-22.
Gamper, G., Havel, C., Arrich, J., Losert, H., Pace, N. L., Müllner, M., & Herkner, H. (2016). Vasopressors for hypotensive shock. Cochrane Database of Systematic Reviews, 2016(2), 1-3. https://doi.org/10.1002/14651858.CD003709.pub4.
Garcia, B., & Legrand, M. (2023). Adjunctive vasopressors in distributive shock: How soon is early? Critical Care, 27(1), 23-24. https://doi.org/10.1186/s13054-023-04500-y.
Geller, B. J., Sinha, S. S., Kapur, N. K., Bakitas, M., Balsam, L. B., Chikwe, J., Klein, D. G., Kochar, A., Masri, S. C., Sims, D. B., Wong, G. C., Katz, J. N., & Van Diepen, S. (2022). Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation, 146(6), E50-E68. https://doi.org/10.1161/CIR.0000000000001076.
Glinka, J., Bruballa, R. C., de Santibañes, M., & Mazza, O. (2019). Hypovolemic shock due to hemorrhage in pancreatic pseudocyst. Medicina (Argentina), 79(6), 31829961.
Gonzalez-Hermosillo, J. A., Palma-Carbajal, R., Rojas-Velasco, G., Cabrera-Jardines, R., GonzalezGalvan, L. M., Manzur-Sandoval, D., Jiménez-Rodriguez, G. M., & Ortiz-Solis, W. A. (2020). Hemodynamic profiles related to circulatory shock in cardiac care units. Archivos de Cardiologia de Mexico, 90(1), 47-54. https://doi.org/10.24875/ACM.19000016.
Gross, S. D. (1976). Shock. Anaesthesia, 31(7), 865-867. https://doi.org/10.1111/j.1365-2044.1976.tb11895.x.
Herget-Rosenthal, S., Saner, F., & Chawla, L. S. (2008). Approach to hemodynamic shock and vasopressors. Clinical Journal of the American Society of Nephrology, 3(2), 546-553. https://doi.org/10.2215/CJN.01820407.
Hernandez-Montfort, J., Sinha, S. S., Thayer, K. L., Whitehead, E. H., Pahuja, M., Garan, A. R., Mahr, C., Haywood, J. L., Harwani, N. M., Schaeffer, A., Wencker, D., Kanwar, M., Vorovich, E., Abraham, J., Burkhoff, D., & Kapur, N. K. (2021). Clinical Outcomes Associated With Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock. Circulation: Heart Failure, 14(5), E007924. https://doi.org/10.1161/CIRCHEARTFAILURE.120.007924.
Jang, D. H., Nelson, L. S., & Hoffman, R. S. (2013). Response to Methylene Blue Does Not Have to Be Considered Only as Rescue Therapy for Distributive Shock. Journal of Medical Toxicology, 9(4), 427. https://doi.org/10.1007/s13181-013-0332-9.
Jardin, F., Gurdjian, F., Desfonds, P., Fouilladieu, J. L., & Margairaz, A. (1979). Hemodynamic factors influencing arterial hypoxemia in massive pulmonary embolism with circulatory failure. Circulation, 59(5), 909-912. https://doi.org/10.1161/01.CIR.59.5.909.
Javali, R. H., Loganathan, A., Srinivasarangan, M., Patil, A., Siddappa, G. B., Satyanarayana, N., Bheemanna, A. S., Jagadeesh, S., & Betkerur, S. (2020). Reliability of emergency department diagnosis in identifying the etiology of nontraumatic undifferentiated hypotension. Indian Journal of Critical Care Medicine, 24(5), 313-320. https://doi.org/10.5005/jp-journals-10071-23429.
Kamada, A., Komatsu, T., Asako, S., Mizuno, K., Takami, H., Nomura, T., & Sugita, M. (2022). A rare distributive shock diagnosed only by medical history and inspection. Clinical Case Reports, 10(12), 1-2. https://doi.org/10.1002/ccr3.6746.
Kashani, K., Omer, T., & Shaw, A. D. (2022). The Intensivist’s Perspective of Shock, Volume Management, and Hemodynamic Monitoring. Clinical Journal of the American Society of Nephrology, 17(5), 706-716. https://doi.org/10.2215/CJN.14191021.
Khalif, A., Dumont, T., & Ranganathan, K. (2022). Cardiogenic Shock and Temporary Mechanical Circulatory Support. Critical Care Nursing Quarterly, 45(3), 218-224. https://doi.org/10.1097/CNQ.0000000000000406.
Kobayashi, L., Costantini, T. W., & Coimbra, R. (2012). Hypovolemic Shock Resuscitation. Surgical Clinics of North America, 92(6), 1403-1423. https://doi.org/10.1016/j.suc.2012.08.006.
Kumar, M. P., Thyagarajan, B., Haller, N., & Ciltea, D. (2019). A diagnostic conundrum of distributive shock: Autoimmune polyglandular syndrome type II. Indian Journal of Critical Care Medicine, 23(12), 582-583. https://doi.org/10.5005/jp-journals-10071-23297.
Lala, A., Guo, Y., Xu, J., Esposito, M., Morine, K., Karas, R., Katz, S. D., Hochman, J. S., Burkhoff, D., & Kapur, N. K. (2018). Right Ventricular Dysfunction in Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Hemodynamic Analysis of the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) Trial and Registry. Journal of Cardiac Failure, 24(3), 148-156. https://doi.org/10.1016/j.cardfail.2017.10.009.
Lier, H., Bernhard, M., & Hossfeld, B. (2018). Hypovolämisch-hämorrhagischer Schock. Anaesthesist, 67(3), 225-244. https://doi.org/10.1007/s00101-018-0411-z.
Lier, H., & Fries, D. (2021). Emergency Blood Transfusion for Trauma and Perioperative Resuscitation: Standard of Care. Transfusion Medicine and Hemotherapy, 48(6), 366-376. https://doi.org/10.1159/000519696.
Mendes, L. A., Picard, M. H., Sleeper, L. A., Thompson, C. R., Jacobs, A. K., White, H. D., Hochman, J. S., & Davidoff, R. (2005). Cardiogenic shock: Predictors of outcome based on right and left ventricular size and function at presentation. Coronary Artery Disease, 16(4), 209-215. https://doi.org/10.1097/00019501-200506000-00001.
Menon, V., Slater, J. N., White, H. D., Sleeper, L. A., Cocke, T., & Hochman, J. S. (2000). Acute myocardial infarction complicated by systemic hypoperfusion without hypotension: Report of the SHOCK trial registry. American Journal of Medicine, 108(5), 374-380. https://doi.org/10.1016/S0002-9343(00)00310-7.
Meyer, G., & Sanchez, O. (2000). [Acute circulatory failure caused by primary pulmonary hypertension or pulmonary embolism]. Revue Des Maladies Respiratoires, 17(1), 51-65.
Morales, G., Adedipe, A., Morse, S., McCabe, J., Mahr, C., & Nichol, G. (2022). Feasibility of Very Early Identification of Cardiogenic Shock by Semi-automated Ultrasound Exam in the Emergency Department. Cureus, 14(10). https://doi.org/10.7759/cureus.30927.
Morita, S., Sakurai, K., Watanabe, Y., & Nishino, T. (2014). Obstructive shock caused by a giant hiatus hernia. Internal Medicine, 53(23), 2755. https://doi.org/10.2169/internalmedicine.53.3280.
Musikatavorn, K., Plitawanon, P., Lumlertgul, S., Narajeenron, K., Rojanasarntikul, D., Tarapan, T., & Saoraya, J. (2021). Randomized controlled trial of ultrasound-guided fluid resuscitation of sepsis-induced hypoperfusion and septic shock. Western Journal of Emergency Medicine, 22(2), 369-378. https://doi.org/10.5811/WESTJEM.2020.11.48571.
Ostadal, P., & Belohlavek, J. (2024). What is cardiogenic shock? New clinical criteria urgently needed. Current Opinion in Critical Care, 1-2. https://doi.org/10.1097/mcc.0000000000001172.
Parlow, S., Cheung, M., Verreault-Julien, L., Wu, K. Y., Berardi, P., Nair, V., Di Santo, P., Jung, R. G., Mathew, R., & Hibbert, B. (2021). An Unusual Case of Obstructive Shock. JACC: Case Reports, 3(18), 1913-1917. https://doi.org/10.1016/j.jaccas.2021.10.017.
Peach, M., Milne, J., Diegelmann, L., Lamprecht, H., Stander, M., Lussier, D., Pham, C., Henneberry, R., Fraser, J., Chandra, K., Howlett, M., Mekwan, J., Ramrattan, B., Middleton, J., van Hoving, N., Taylor, L., Dahn, T., Hurley, S., MacSween, K., Richardson, L., Stoica, G., Hunter, S., Olszynski, P., Chandra, K., Lewis, D., & Atkinson, P. (2023). Does point-of-care ultrasonography improve diagnostic accuracy in emergency department patients with undifferentiated hypotension? international randomized controlled trial from the SHOC-ED investigators. Canadian Journal of Emergency Medicine, 25(1), 48-56. https://doi.org/10.1007/s43678-022-00431-9.
Pepe, P. E. (2003). Shock in polytrauma. British Medical Journal, 327(7424), 1119-1120. https://doi.org/10.1136/bmj.327.7424.1119.
Pessoa, S. M. B., Oliveira, B. S. de S., Santos, W. G. Dos, Oliveira, A. N. M., Camargo, M. S., Matos, D. L. A. B. de, Silva, M. M. L., Medeiros, C. C. de Q., Coelho, C. S. de S., Andrade Neto, J. de S., & Mistro, S. (2022). Prediction of septic and hypovolemic shock in intensive care unit patients using machine learning. Revista Brasileira de Terapia Intensiva, 34(4), 477-483. https://doi.org/10.5935/0103-507X.20220280-pt.
Pich, H., & Heller, A. R. (2015). Obstruktiver Schock. Anaesthesist, 64(5), 403-419. https://doi.org/10.1007/s00101-015-0031-9.
Pourmand, A., Pyle, M., Yamane, D., Sumon, K., & Frasure, S. E. (2019). The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients. World Journal of Emergency Medicine, 10(4), 232-238. https://doi.org/10.5847/wjem.j.1920-8642.2019.04.007.
Rydzek, J., Barziej, I., Hasij, J., Dlugosz, A., & Kaptacz, A. (2010). [Pericarditis and cardiac tamponade in patient with pulmonary embolism]. Wiad Lek, 63(2), 54-60.
Safiejko, K., Smereka, J., Pruc, M., Ladny, J. R., Jaguszewski, M. J., Filipiak, K. J., Yakubtsevich, R., & Szarpak, L. (2022). Efficacy and safety of hypertonic saline solutions fluid resuscitation on hypovolemic shock: A systematic review and meta-analysis of randomized controlled trials. Cardiology Journal, 29(6), 966-977. https://doi.org/10.5603/CJ.a2020.0134.
Scholz, K. H. (1999). Reperfusion therapy and mechanical circulatory support in cardiogenic shock. Herz, 24(6), 448-464. https://doi.org/10.1007/bf03044431.
Sheehan, J. R., Keating, L., Chan, A., & Walden, A. (2013). Distributive shock due to systemic capillary leak syndrome treated with high-dose immunosuppression. BMJ Case Reports, 1-2. https://doi.org/10.1136/bcr-2013-009048.
Shimono, H., Kajiya, T., Saku, K., Ueno, M., Takaoka, J., Atsuchi, Y., Atsuchi, N., & Ohishi, M. (2019). Obstructive shock with mediastinal hematoma caused by chest compressions after successful primary percutaneous coronary intervention. Journal of Cardiology Cases, 20(3), 92-94. https://doi.org/10.1016/j.jccase.2019.05.002.
Simmons, J., & Ventetuolo, C. E. (2017). Cardiopulmonary monitoring of shock. Current Opinion in Critical Care, 23(3), 223-231. https://doi.org/10.1097/MCC.0000000000000407.
Smalling, R. W., Sweeney, M., Lachterman, B., Hess, M. J., Morris, R., Anderson, H. V., Heibig, J., Li, G., Willerson, J. T., Frazier, O. H., & Wampler, R. K. (1994). Transvalvular left ventricular assistance in cardiogenic shock secondary to acute myocardial infarction. Evidence for recovery from near fatal myocardial stunning. Journal of the American College of Cardiology, 23(3), 637-644. https://doi.org/10.1016/0735-1097(94)90748-X.
Song, X., Liu, X., Evans, K. D., Frank, R. D., Barreto, E. F., Dong, Y., Liu, C., Gao, X., Wang, C., & Kashani, K. B. (2021). The order of vasopressor discontinuation and incidence of hypotension: a retrospective cohort analysis. Scientific Reports, 11(1), 1-2. https://doi.org/10.1038/s41598-021-96322-7.
Soong, J. T. Y., & Soni, N. (2013). Circulatory shock. Medicine (United Kingdom), 41(2), 64-69. https://doi.org/10.1016/j.mpmed.2012.11.012.
Standl, T., Annecke, T., Cascorbi, I., Heller, A. R., Sabashnikov, A., & Teske, W. (2018). The Nomenclature, Definition and Distinction of Types of Shock. Deutsches Arzteblatt International, 115(45), 757-767. https://doi.org/10.3238/arztebl.2018.0757.
Stickles, S. P., Carpenter, C. R., Gekle, R., Kraus, C. K., Scoville, C., Theodoro, D., Tran, V. H., Ubiñas, G., & Raio, C. (2019). The diagnostic accuracy of a point-of-care ultrasound protocol for shock etiology: A systematic review and meta-analysis. Canadian Journal of Emergency Medicine, 21(3),406-417. https://doi.org/10.1017/cem.2018.498.
Tewelde, S. Z., Liu, S. S., & Winters, M. E. (2018). Cardiogenic Shock. Cardiology Clinics, 36(1), 53-61.
https://doi.org/10.1016/j.ccl.2017.08.009.
Vahdatpour, C., Collins, D., & Goldberg, S. (2019). Cardiogenic Shock. Journal of the American Heart Association, 8(8), 30947630. https://doi.org/10.1161/JAHA.119.011991.
Verras, C., Ventoulis, I., Bezati, S., Matsiras, D., Parissis, J., & Polyzogopoulou, E. (2023). Point of Care Ultrasonography for the Septic Patient in the Emergency Department: A Literature Review. Journal of Clinical Medicine, 12(3), 12031105. https://doi.org/10.3390/jcm12031105.
Vignon, P., Repessé, X., Begot, E., Léger, J., Jacob, C., Bouferrache, K., Slama, M., Prat, G., & Vieillard-Baron, A. (2017). Comparison of echocardiographic indices used to predict fluid responsiveness in ventilated patients. American Journal of Respiratory and Critical Care Medicine, 195(8), 1022-1032. https://doi.org/10.1164/rccm.201604-0844OC.
Vincent, J. L., & Leone, M. (2017). Optimum treatment of vasopressor-dependent distributive shock. Expert Review of Anti-Infective Therapy, 15(1), 5-10. https://doi.org/10.1080/14787210.2017.1252673.
Wacker, D. A., & Winters, M. E. (2014). Shock. Emergency Medicine Clinics of North America, 32(4), 747-758. https://doi.org/10.1016/j.emc.2014.07.003.
Wang, J., Liang, T., Louis, L., Nicolaou, S., & McLaughlin, P. D. (2013). Hypovolemic shock complex in the trauma setting: A pictorial review. Canadian Association of Radiologists Journal, 64(2), 156-163. https://doi.org/10.1016/j.carj.2013.03.002.
Yan, Z., Linfeng, D., Lu, C., Jun, L., Yinghao, P., & Jian, W. (2020). Inferior vena cava diameter combined with lung ultrasound B-line score to guide fluid resuscitation in patients with septic shock. Chinese Critical Care Medicine, 32(11), 1356-1360. https://doi.org/10.3760/cma.j.cn121430-20200611-00463.
Yoshida, T., Yoshida, T., Noma, H., Nomura, T., Suzuki, A., & Mihara, T. (2023). Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis. Critical Care, 27(1). https://doi.org/10.1186/s13054-023-04495-6.