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Echocardiography in the Intensive Care Unit

  • Critical Care Anesthesia (BS Rasmussen, Section Editor)
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Abstract

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.

Recent Findings

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.

Summary

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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Longobardo L, Zito C, Carerj S, Caracciolo G, Khandheria BK. Role of echocardiography in the intensive care unit: overview of the most common clinical scenarios. J Patient Cent Res Rev. 2018;5:239–43.

    PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  Google 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.

    PubMed  Google 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.

    PubMed  Google Scholar 

  5. Hastie J, Panzer OPF, Weyker P, Flynn BC. Miniaturized echocardiography in the cardiac intensive care unit. J Cardiothorac Vasc Anesth. 2018;33:1540–7. https://doi.org/10.1053/j.jvca.2018.08.199.

    Article  PubMed  Google 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.

    PubMed  Google Scholar 

  7. Singh K, Mayo P. Critical care echocardiography and outcomes in the critically ill. Curr Opin Crit Care. 2018;24:316–21.

    PubMed  Google Scholar 

  8. Hernandez-Torres V, Prada G, Diaz-Gomez JL. Critical care echocardiography-embracing the future today. Int Anesthesiol Clin. 2019;57:75–88.

    PubMed  Google 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 

  12. Shah BN, Ahmadvazir S, Pabla JS, Zacharias K, Senior R. The role of urgent transthoracic echocardiography in the evaluation of patients presenting with acute chest pain. Eur J Emerg Med. 2012;19:277–83.

    PubMed  Google Scholar 

  13. Smith JS, Cahalan MK, Benefiel DJ, Byrd BF, Lurz FW, Shapiro WA, et al. Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography. Circulation. 1985;72:1015–21.

    CAS  PubMed  Google Scholar 

  14. Poelaert JI, Bouchez S. Perioperative echocardiographic assessment of mitral valve regurgitation: a comprehensive review. Eur J Cardiothorac Surg. 2016;50:801–12.

    PubMed  Google Scholar 

  15. Mebazaa A, Tolppanen H, Mueller C, Lassus J, DiSomma S, Baksyte G, et al. Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance. Intensive Care Med. 2016;42:147–63.

    CAS  PubMed  Google Scholar 

  16. Suarez JC, Lopez P, Mancebo J, Zapata L. Diastolic dysfunction in the critically ill patient. Med Int. 2016;40:499–510.

    CAS  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.

    PubMed  Google Scholar 

  18. Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung ultrasound for critically ill patients. Am J Respir Crit Care Med. 2019;199:701–14.

    PubMed  Google 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 

  20. Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J. 2016;37:2097–104.

    PubMed  PubMed Central  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.

    PubMed  PubMed Central  Google Scholar 

  22. Swaminathan M, Nicoara A, Phillips-Bute BG, Aeschlimann N, Milano CA, Mackensen GB, et al. Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery. Ann Thorac Surg. 2011;91:1844–50.

    PubMed  Google Scholar 

  23. Roche Campo F, Bedet A, Vivier E, Brochard L, Mekontso Dessap A. Cardiac function during weaning failure: the role of diastolic dysfunction. Ann Intensive Care. 2018;8:2.

    PubMed  PubMed Central  Google Scholar 

  24. de Meirelles Almeida CA, Nedel WL, Morais VD, Boniatti MM, de Almeida-Filho OC. Diastolic dysfunction as a predictor of weaning failure: a systematic review and meta-analysis. J Crit Care. 2016;34:135–41.

    PubMed  Google Scholar 

  25. Barbier C, Loubières Y, Schmit C, Hayon J, Ricôme J-L, Jardin F, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. 2004;30:1740–6.

    PubMed  Google 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.

    PubMed  PubMed Central  Google Scholar 

  27. Charron C, Caille V, Jardin F, Vieillard-Baron A. Echocardiographic measurement of fluid responsiveness. Curr Opin Crit Care. 2006;12:249–54.

    PubMed  Google Scholar 

  28. Vieillard-Baron A, Slama M, Cholley B, Janvier G, Vignon P. Echocardiography in the intensive care unit: from evolution to revolution? Intensive Care Med. 2008;34:243–9.

    PubMed  Google 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.

    PubMed  Google Scholar 

  30. Kronzon I, Cohen ML, Winer HE. Contribution of echocardiography to the understanding of the pathophysiology of cardiac tamponade. J Am Coll Cardiol. 1983;1:1180–2.

    CAS  PubMed  Google Scholar 

  31. Fowler NO. Cardiac tamponade. A clinical or an echocardiographic diagnosis? Circulation. 1993;87:1738–41.

    CAS  PubMed  Google Scholar 

  32. Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest. 2002;121:877–905.

    PubMed  Google Scholar 

  33. McIntyre KM, Sasahara AA. The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease. Am J Cardiol. 1971;28:288–94.

    CAS  PubMed  Google Scholar 

  34. Kasper W, Geibel A, Tiede N, Bassenge D, Kauder E, Konstantinides S, et al. Distinguishing between acute and subacute massive pulmonary embolism by conventional and Doppler echocardiography. Br Heart J. 1993;70:352–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. McConnell MV, Solomon SD, Rayan ME, Come PC, Goldhaber SZ, Lee RT. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol. 1996;78:469–73.

    CAS  PubMed  Google Scholar 

  36. Kurzyna M, Torbicki A, Pruszczyk P, Burakowska B, Fijałkowska A, Kober J, et al. Disturbed right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism. Am J Cardiol. 2002;90:507–11.

    PubMed  Google Scholar 

  37. Kurnicka K, Lichodziejewska B, Goliszek S, Dzikowska-Diduch O, Zdończyk O, Kozłowska M, et al. Echocardiographic pattern of acute pulmonary embolism: analysis of 511 consecutive patients. J Am Soc Echocardiogr. 2016;29:907–13.

    PubMed  Google Scholar 

  38. Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Hemodynamic instability in sepsis: bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med. 2003;168:1270–6.

    PubMed  Google Scholar 

  39. Bouhemad B, Nicolas-Robin A, Arbelot C, Arthaud M, Féger F, Rouby J-J. Isolated and reversible impairment of ventricular relaxation in patients with septic shock. Crit Care Med. 2008;36:766–74.

    PubMed  Google Scholar 

  40. Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med. 2008;36:1701–6.

    PubMed  Google Scholar 

  41. Gonzalez C, Begot E, Dalmay F, et al. Prognostic impact of left ventricular diastolic function in patients with septic shock. Ann Intensive Care. 2016;6:36.

    PubMed  PubMed Central  Google 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Reynolds HR, Jagen MA, Tunick PA, Kronzon I. Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era. J Am Soc Echocardiogr. 2003;16:67–70.

    PubMed  Google Scholar 

  44. Habib G, Badano L, Tribouilloy C, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010;11:202–19.

    PubMed  Google 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.

    PubMed  Google Scholar 

  46. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994;96:200–9.

    CAS  PubMed  Google 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.

    CAS  PubMed  Google Scholar 

  48. Ibrahim M, Rao C, Ashrafian H, Chaudhry U, Darzi A, Athanasiou T. Modern management of systolic anterior motion of the mitral valve. Eur J Cardiothorac Surg. 2012;41:1260–70.

    PubMed  Google Scholar 

  49. Slama M, Tribouilloy C, Maizel J. Left ventricular outflow tract obstruction in ICU patients. Curr Opin Crit Care. 2016;22:260–6.

    PubMed  Google Scholar 

  50. Zhang Z. Echocardiography for patients undergoing extracorporeal cardiopulmonary resuscitation: a primer for intensive care physicians. J Intensive Care. 2017;5:15.

    PubMed  PubMed Central  Google 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.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology 2K12C, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Stefaan Bouchez & Patrick F. Wouters

  2. Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium

    Patrick F. Wouters

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  1. Stefaan Bouchez
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Correspondence to Stefaan Bouchez.

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Stefaan Bouchez and Patrick F. Wouters declare they have no conflict of interest.

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Bouchez, S., Wouters, P.F. Echocardiography in the Intensive Care Unit. Curr Anesthesiol Rep 9, 360–367 (2019). https://doi.org/10.1007/s40140-019-00336-x

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