Pericardial Effusion in Intensive Care Medicine — Clinical and Echocardiographic Diagnosis of Cardiac Tamponade — Emergency Pericardial Drainage

Abstract

Cardiac tamponade, defined by acute circulatory failure secondary to compression of the heart chambers by pericardial effusion, causes obstructive shock requiring intensive care. The incidence of cardiac tamponade in the intensive care unit (ICU) is poorly documented, but pericardial effusion seems to be associated with increased mortality. Pericardial effusion may be caused by infectious, malignant, or autoimmune diseases, and occurs frequently after cardiac surgery. It may be suspected in any patient with shock and signs of right heart failure and polypnea, but echocardiography is crucial in the diagnosis as it visualizes pericardial effusion and detects poor hemodynamic tolerance with diastolic collapse of the right chambers and respiratory variation of right and left Doppler flows. Pericardial drainage, by pericardiocentesis or pericardiotomy, remains the only effective treatment in an emergency situation. Symptomatic treatments are mandatory before drainage to improve venous return despite pericardial obstruction: cautious volume expansion in documented hypovolemia, or norepinephrine, while minimizing the use of mechanical ventilation and sedation as these may increase circulatory failure and lead to cardiac arrest.