Echocardiography in the Intensive Care Unit
- 74 Downloads
Purpose of Review
This review illustrates the incremental value of echocardiography as a bedsite tool for diagnosis and monitoring in critically ill patients with cardiopulmonary dysfunction. It provides practical guidance on the use of basic echocardiography in clinical scenarios frequently encountered in the ICU.
Echocardiography has become readily accessible to critical care physicians now and equipment is even been designed specifically for use in acute and critical care environments. The most important barrier to a more widespread implementation of this technique today, however, is the lack of training and experience. Indeed, proficiency is an absolute requirement for echo-based decision-making to positively impact on patient outcome.
Echocardiography has become an indispensable tool in the management of critically ill patients with severe cardiorespiratory conditions. It has the potential to become a game changer in ICU but current studies do not yet indicate a beneficial effect on outcome. It appears that structured training and certification in basic echocardiography are an absolute necessity to catalyze the widespread adoption and to guarantee the optimal use of ultrasound in the care of critically ill patients.
KeywordsEchocardiography Monitoring Hemodynamic Cardiac function Critical care Acute respiratory failure Acute circulatory failure Dyspnea Hypotension Diagnosis
Compliance with Ethical Standards
Conflict of Interest
Stefaan Bouchez and Patrick F. Wouters declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.• Cardim N, Dalen H, Voigt J-U, Ionescu A, Price S, Neskovic AN, et al. The use of handheld ultrasound devices: a position statement of the European Association of Cardiovascular Imaging (2018 update). Eur Heart J Cardiovasc Imaging. 2019;20:245–52. A very important paper that addresses the most important aspects related to the use of handheld ultrasound devices. The authors provide guidance and recommendations as they recognize the potential benefit of partial focused ultrasound exams with these devices, but also caution against the drawbacks from inappropriate use of this technology. PubMedGoogle Scholar
- 3.Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Coll Cardiol. 2003;42:954–70.PubMedGoogle Scholar
- 4.Reeves ST, Finley AC, Skubas NJ, Swaminathan M, Whitley WS, Glas KE, et al. Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26:443–56.PubMedGoogle Scholar
- 6.Hlaing M, He J, Haglund N, Takayama H, Flynn BC. Impact of a monoplane hemodynamic TEE (hTEE) monitoring device on decision making in a heterogeneous hemodynamically unstable intensive care unit population: a prospective, observational study. J Cardiothorac Vasc Anesth. 2018;32:1308–13.PubMedGoogle Scholar
- 9.Cholley BP, Mayo PH, Poelaert J, et al. International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37:1077–83.Google Scholar
- 10.Vieillard-Baron A, Mayo PH, Vignon P, et al. International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med. 2014;40:654–66.Google Scholar
- 11.Mathew J. Clinical manual and review of transesophageal echocardiography. Third Edition. New York: Mc Graw Hill; 2019. p. p591.Google Scholar
- 16.Suarez JC, Lopez P, Mancebo J, Zapata L. Diastolic dysfunction in the critically ill patient. Med Int. 2016;40:499–510.Google Scholar
- 17.Nagueh SF, Smiseth OA, Appleton CP, Byrd BF III, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:1321–60.PubMedGoogle Scholar
- 19.Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. Am J Respir Crit Care Med. 2012;156:1640–6.Google Scholar
- 21.•• Lichtenstein DA. Novel approaches to ultrasonography of the lung and pleural space: where are we now? Breathe. 2017;13:100–11. This review article updates the reader on the essential knowledge and skills required to practice lung ultrasound in the critically ill patient. PubMedPubMedCentralGoogle Scholar
- 26.Cannesson M, Slieker J, Desebbe O, Farhat F, Bastien O, Lehot J-J. Prediction of fluid responsiveness using respiratory variations in left ventricular stroke area by transoesophageal echocardiographic automated border detection in mechanically ventilated patients. Crit Care. 2006;10:R171.PubMedPubMedCentralGoogle Scholar
- 29.• Vignon P, Merz TM, Vieillard-Baron A. Ten reasons for performing hemodynamic monitoring using transesophageal echocardiography. Intensive Care Med. 2017;43:1048–51. This article pleads for a more liberal use of transesophageal echocardiography (versus the transthoracic or “surface” approach) in mechanically ventilated ICU patients. They list 10 convincing arguments to deviate from the formal indication (i.e., views not accessible, selective diagnostics) in this specific subgroup of patients where the potential (low) risk of a transesophageal approach is outweighed by the cited benefits. PubMedGoogle Scholar
- 42.Sanfilippo F, Corredor C, Fletcher N, Tritapepe L, Lorini FL, Arcadipane A, et al. 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. 2018;22:183.PubMedPubMedCentralGoogle Scholar
- 45.Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:e521–643.PubMedPubMedCentralGoogle Scholar
- 47.Maslow AD, Regan MM, Haering JM, Johnson RG, Levine RA. Echocardiographic predictors of left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease. J Am Coll Cardiol. 1999;34:2096–104.PubMedGoogle Scholar
- 51.•• Bouchez S, Van Belleghem Y, De Somer F, De Pauw M, Stroobandt R, Wouters P. Haemodynamic management of patients with left ventricular assist devices using echocardiography: the essentials. Eur Heart J Cardiovasc Imaging. 2019;20:373–82. This article provides comprehensive instructions on the use of echocardiography as a base for decision-making in a challenging clinical context. The number of patients treated with mechanical support systems is increasing, yet there is very little supportive educational guidance in today’s scientific literature. PubMedGoogle Scholar