Case study 1

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A 57 years old man was admitted to the intensive care unit for septic shock. 

His previous medical history was significant liver transplant 1 month prior to hospitalization. The liver transplant was indicated for end-stage liver failure post hepatitis C.  A recent pre-transplant workup had been normal, including normal stress echocardiography.

In the intensive care unit, the patient was treated by broad-spectrum antibiotics, aggressive volume ressuscitation and vasopressors (epinephrine and norepinephrine). Despite optimal treatment, the hemodynamic instability persisted with apparition of bilateral lung effusions and worsening respiratory parameters.

Decision was made to perform goal-directed transthoracic echocardiography to reassess the left ventricular function and volume status:

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