What is the role of hemodynamic support in the treatment of pericardial effusion?

Updated: Nov 28, 2018
  • Author: William J Strimel, DO, FACP; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Patients who have an effusion with actual or threatened tamponade should be considered to have a true or potential emergency. Most patients require pericardiocentesis to treat or prevent tamponade. However, treatment should be carefully individualized.

Hemodynamic monitoring with a balloon flotation pulmonary artery catheter is useful, especially in patients with tamponade or threatened tamponade in whom a decision is made to defer pericardiocentesis. Hemodynamic monitoring is also helpful after pericardiocentesis to assess reaccumulation and the presence of underlying constrictive disease. However, insertion of a pulmonary artery catheter should not be allowed to delay definitive therapy in critically ill patients.

IV fluid resuscitation may be helpful in cases of hemodynamic compromise. In patients with tamponade who are critically ill, IV positive inotropes (dobutamine, dopamine) can be used but are of limited use and should not be allowed to substitute for or delay pericardiocentesis.


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