A decade of progress in critical care echocardiography: a narrative review
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This narrative review focusing on critical care echocardiography (CCE) has been written by a group of experts in the field, with the aim of outlining the state of the art in CCE in the 10 years after its official recognition and definition.
In the last 10 years, CCE has become an essential branch of critical care ultrasonography and has gained general acceptance. Its use, both as a diagnostic tool and for hemodynamic monitoring, has increased markedly, influencing contemporary cardiorespiratory management. Recent studies suggest that the use of CCE may have a positive impact on outcomes. CCE may be used in critically ill patients in many different clinical situations, both in their early evaluation of in the emergency department and during intensive care unit (ICU) admission and stay. CCE has also proven its utility in perioperative settings, as well as in the management of mechanical circulatory support. CCE may be performed with very simple diagnostic objectives. This application, referred to as basic CCE, does not require a high level of training. Advanced CCE, on the other hand, uses ultrasonography for full evaluation of cardiac function and hemodynamics, and requires extensive training, with formal certification now available. Indeed, recent years have seen the creation of worldwide certification in advanced CCE. While transthoracic CCE remains the most commonly used method, the transesophageal route has gained importance, particularly for intubated and ventilated patients.
CCE is now widely accepted by the critical care community as a valuable tool in the ICU and emergency department, and in perioperative settings.
KeywordsCritical care echocardiography Transthoracic echocardiography Transesophageal echocardiography Ultrasonography Hemodynamic monitoring
Compliance with ethical standards
Conflicts of interest
AVB has received grant funds from GSK for conducting clinical research and was a member of the scientific advisory board for the study. SJM declares no conflict of interest. FSF declares no conflict of interest. MC has received honoraria and travel grants from Edwards Lifesciences. JDG declares no conflict of interest. AML declares no conflict of interest. MRP has received honoraria for lectures from Edwards Lifesciences, Cheetah Medical and LiDCO Ltd and is a scientific advisor to Edwards Lifesciences and LiDCO Ltd. JP declares no conflict of interest. PM declares no conflict of interest. NF declares no conflict of interest.
An approval by an ethics committee was not applicable.
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- 7.Mercado P, Maizel J, Beyls C, Kontar L, Orde S, Huang S, McLean A, Tribouilloy C, Slama M (2019) Reassessment of the accuracy of cardiac Doppler pulmonary artery pressure measurements in ventilated ICU patients: a simultaneous Doppler-catheterization study. Crit Care Med 47:41–48CrossRefGoogle Scholar
- 16.Cook CH, Praba AC, Beery PR, Martin LC (2002) Transthoracic echocardiography is not cost-effective in critically ill surgical patients. J Trauma 52:280–284Google Scholar
- 17.Lhéritier G, Legras A, Caille A, Lherm T, Mathonnet A, Frat JP, Courte A, Martin- Lefèvre L, Gouëllo JP, Amiel JB, Garot D, Vignon P (2013) Prevalence and prognostic value of acute cor pulmonale and patent foramen ovale in ventilated patients with early acute respiratory distress syndrome: a multicenter study. Intensive Care Med 39:1734–1742CrossRefGoogle Scholar
- 25.Hibbert B, Simard T, Ramirez FD (2018) Impact of routine handheld focused cardiac ultrasonography on the diagnosis and management of hospitalized cardiac patients: the CAPITAL FoCUS Registry. https://www.ahajournals.org/doi/abs/10.1161/circ.134.suppl_1.20662. Accessed 10 Oct 2018
- 29.Nazerian P, Vanni S, Zanobetti M, Polidori G, Pepe G, Federico R, Cangioli E, Grifoni S (2010) Diagnostic accuracy of emergency Doppler echocardiography for identification of acute left ventricular heart failure in patients with acute dyspnea: comparison with Boston criteria and N-terminal prohormone brain natriuretic peptide. Acad Emerg Med 17:18–26CrossRefGoogle Scholar
- 41.Clancy DJ, Scully T, Slama M, Huang S, McLean A, Orde SR (2017) Application of updated guidelines on diastolic dysfunction in patients with severe sepsis and septic shock. Ann Intensive Care 7:121Google Scholar
- 43.Mekontso-Dessap A, Boissier F, Charron C, Bégot E, Repessé X, Legras A, Brun- Buisson C, Vignon P, Vieillard-Baron A (2016) Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact. Intensive Care Med 42:862–70Google Scholar
- 45.Ferrada P, Evans D, Wolfe L, Anand RJ, Vanguri P, Mayglothling J, Whelan J, Malhotra A, Goldberg S, Duane T, Aboutanos M, Ivatury RR (2014) Findings of a randomized controlled trial using limited transthoracic echocardiogram (LTTE) as a hemodynamic monitoring tool in the trauma bay. J Trauma Acute Care Surg 76:31–37CrossRefGoogle Scholar
- 53.Vieillard-Baron A, Evrard B, Repessé X, Maizel J, Jacob C, Goudelin M, Charron C, Prat G, Slama M, Geri G, Vignon P (2018) Limited value of end-expiratory inferior vena cava diameter to predict fluid responsiveness. Impact of intra-abdominal pressure. Intensive Care Med 44:197–203CrossRefGoogle Scholar
- 56.Magder S (2018) Heart-lung interactions in spontaneous breathing subjects: the basics. Ann Transl Med 6:348Google Scholar
- 60.Vieillard-Baron A, Slama M, Mayo P, Charron C, Amiel JB, Esterez C, Leleu F, Repesse X, Vignon P (2013) A pilot study on safety and clinical utility of a single-use 72-hours indwelling transesophageal echocardiography probe. Intensive Care Med 39:629Google Scholar
- 63.Manasia AR, Nagaraj HM, Kodali RB (2005) Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients. J Cardiothorac Vasc Anesth 19:155–159CrossRefGoogle Scholar
- 67.Huang SJ, Ting I, Huang AM, Slama M, McLean AS (2017) Longitudinal wall fractional shortening: an M-mode index based on mitral annular plane systolic excursion (MAPSE) that correlates and predicts left ventricular longitudinal strain (LVLS) in intensive care patients. Crit Care 21:292CrossRefGoogle Scholar
- 70.Sanfilippo F, Corredor C, Fletcher N, Tritapepe L, Lorini FL, Arcadipane A, Vieillard- Baron A, Cecconi M (2018) Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis. Crit Care 22:183CrossRefGoogle Scholar
- 76.Canty DJ, Heiberg J, Yang Y, Royse AG, Margale S, Nanjappa N, Scott D, Maier A, Sessler DI, Chuan A, Palmer A, Bucknill A, French C, Royse CF (2018) Pilot multi-centre randomised trial of the impact of pre-operative focused cardiac ultrasound on mortality and morbidity in patients having surgery for femoral neck fractures (ECHONOF-2 pilot). Anaesthesia 73:428–437Google Scholar
- 77.Lancellotti P, Price S, Edvardsen T et al (2015) The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care 16:119–464Google Scholar
- 78.Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu SC, Stewart W, Picard MH (2014) Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg 118:21–68CrossRefGoogle Scholar
- 80.Canty DJ, Heiberg J, Tan JA, Yang Y, Royse AG, Royse CF, Mobeirek A, Shaer FE, Albacker T, Nazer RI, Fouda M, Bakir BM, Alsaddique AA (2017) Assessment of image quality of repeated limited transthoracic echocardiography after cardiac surgery. J Cardiothorac Vasc Anesth 31:965–972CrossRefGoogle Scholar
- 84.Staudt GE, Shelton K (2018) Development of a rescue echocardiography protocol for noncardiac surgery patients. Anesth Analg. https://doi.org/10.1213/ane.0000000000003569
- 89.Donker DW, Meuwese CL, Braithwaite SA, Broomé M, van der Heijden JJ, Hermens JA, Platenkamp M, de Jong M, Janssen JGD, Balík M, Bělohlávek J (2018) Echocardiography in extracorporeal life support: a key player in procedural guidance, tailoring and monitoring. Perfusion 33:31–41CrossRefGoogle Scholar
- 90.Aissaoui N, Caudron J, Leprince P, Fagon JY, Lebreton G, Combes A, Diebold B (2017) Right-left ventricular interdependence: a promising predictor of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med 43:592–594CrossRefGoogle Scholar
- 102.Swanevelder J, Chin D, Kneeshaw J, Chambers J, Bennett S, Smith D, Nihoyannopoulos P (2003) Accreditation in transesophageal echocardiography: statement from the Association of Cardiothoracic Anaesthetists and the British Society of Echocardiography Joint TOE Accreditation Committee. Br J Anaesth 91:469–472CrossRefGoogle Scholar
- 103.Fox KF, Popescu BA, Janiszewski S, Nihoyannopoulos P, Fraser AG, Pinto FJ (2007) Report on the European Association of Echocardiography accreditations in echocardiography: December 2003-September 2006. Eur J Echocardiogr 8:74–79. http://www.uvsq.fr/diu-techniques-ultrasoniques-en-anesthesie-et-en-reanimation-148919.kjsp
- 107.Goudelin M, Evrard B, Dalmay F, Padilla AH, Gonzalez C, Lafon T, Daix T, Fedould AL, François B, Vignon P (2018) Diagnostic capability of a next-generation, ultra- miniaturized ultrasound system in patients with cardiopulmonary compromise assessed using basic critical care echocardiography. Intensive Care Med 44:1579–1581CrossRefGoogle Scholar