Fig. 3

TEE Doppler assessment of cardiac output in a community-acquired pneumonia patient with septic shock (same patient of Fig. 5). Patient is hypotensive and badly perfused and 2D images show a pattern of biventricular dysfunction. LVOT diameter is measured in a mid-esophageal long axis view (a, red double-headed arrow) and LVOT cross sectional area calculated (LVOT diameter = 2.23 cm; CSA = 1.115 cm × 1.115 cm × 3.14 = 3.90 cm²). Measured LVOT VTI (panel 3B, TEE transgastric long axis view) is 8.7 cm, calculated stroke volume is 34 ml (3.90 cm² × 8.7 cm), and heart rate 104 bpm, yielding a CO of 3.55 L/min. Epinephrine infusion [0.01 mcg/(kg min)] restores adequate pressures and flows, increasing LVOT VTI to 12.7 cm, SV to 49 ml (3.90 cm² × 12.7 cm), heart rate to 120 bpm and CO to 5.83 L/min (c). LVOT left ventricular outflow tract, VTI Doppler velocity–time integral, CO cardiac output