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Thoracic Trauma

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Hemodynamic Monitoring Using Echocardiography in the Critically Ill

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Abstract

In blunt thoracic trauma, echocardiography is indicated to diagnose aortic and cardiac trauma. Aortic trauma, trauma to large vessels should be identified. Cardiac trauma mostly consists of pericardial effusion (eventually leading to tamponade) and myocardial contusion (mainly the right ventricle); it occasionally includes valvular disease.

For aortic trauma, the transesophageal approach should be preferred. Even though the suprasternal route allows visualization of the aortic arch in transthoracic echocardiography, image resolution is insufficient to rule out aortic trauma. For cardiac trauma, the evaluation of the patient in shock is often accomplished in two steps. The first step is obtained within a few minutes after hospital admission at the time of initial assessment and orientation of the polytraumatized patient. The transthoracic route, and especially the subxiphoidal view, allows the rapid exclusion of pericardial tamponade and severe myocardial contusion. The second step evaluating the integrity of the cardiac valves and other structures can be performed later, depending on hemodynamic stability and other lesions and priorities. When a lesion is identified, it is important to put it in the clinical scenario to understand its relevance to the hemodynamic compromise and to define priorities in the therapeutic approach.

In addition, it is essential to look for signs of hypovolemia and fluid responsiveness. Echocardiographic examinations often have to be repeated after initial assessment: some lesions may be missed initially since they are masked by more severe lesions, e.g., right ventricular dysfunction may be missed in severe hypovolemia.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Ca’ Foncello Hospital, Treviso, Italy

    Fabio Chirillo

  2. Piazza Ospedale 1, 31100, Treviso, Italy

    Fabio Chirillo

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  1. Fabio Chirillo
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Correspondence to Fabio Chirillo .

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Editors and Affiliations

  1. , Department of Intenisve Care, Erasme University Hospital, route de Lennik 808, Bruxelles, 1070, Belgium

    Daniel de Backer

  2. Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, rue Ambroise Paré 2, Paris CX 10, 75475, France

    Bernard P. Cholley

  3. , Unité de Réanimation Médicale, Centre Hospitalier Universitaire, Avenue Laennec, Amiens Cedex 1, 80054, France

    Michel Slama

  4. Ambroise Paré, Intensive Care & Reanimation Unit, Centre Hospitalier Universitaire, avenue Charles de Gaulle 9, Boulogne Cedex, 92104, France

    Antoine Vieillard-Baron

  5. Hôpital Dupuytren, Dépt. Soin Intensive, Université de Limoges, avenue Martin Luther King 2, Limoges, 87042, France

    Philippe Vignon

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Chirillo, F. (2011). Thoracic Trauma. In: de Backer, D., Cholley, B., Slama, M., Vieillard-Baron, A., Vignon, P. (eds) Hemodynamic Monitoring Using Echocardiography in the Critically Ill. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-87956-5_18

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  • DOI: https://doi.org/10.1007/978-3-540-87956-5_18

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-87954-1

  • Online ISBN: 978-3-540-87956-5

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