Echocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Focus-Oriented, and Comprehensive Examination

Abstract

Echocardiography is applied in the emergency and ICU setting according to specific needs, at different times during the clinical course, and with different modalities. Focus-oriented or goal-directed clinical interrogation occurs any time during the clinical course of hospitalization in order to answer a specific question. For very unstable patients, the ultrasonographic assessment will only concentrate on the essential information that can be obtained in a few minutes or even seconds. A systematic assessment implies the need for substantial experience and mastery of most of the echocardiographic techniques. In the acute phase of hemodynamic instability, the echocardiographic assessment is regularly repeated to check the clinical evolution and the response to management according to specific therapeutic goals (echocardiographic monitoring). In echocardiography in the ICU, acute changes are often superimposed on chronic alterations and remodeling. Since new-onset modification overlaps with preexisting alteration, the intensivist ultrasonography operator is faced with and must interpret a myriad of different and complex findings to obtain the general ultrasonographic morphofunctional assessment of the patient’s heart (echocardiographic history).