OVERVIEW
Echocardiography in Intensive Care allows direct visualisation of the heart, vessels and pleura
INDICATIONS
Assessment of:
- preload
- ventricular function
- afterload
- valvular function
- aortic dissection
- pericardial disease
American College of Cardiology Guidelines for ECHO in the Critically Ill
Category I (useful and effective)
- haemodynamically instability
- suspected aortic dissection or aortic injury
- multiple trauma
- chest trauma
Category II (may be beneficial)
- cardiac output monitoring
Category III (unlikely to benefit and may cause harm)
- the haemodynamically stable with no abnormal findings or cardiac disease
ARGUMENTS FOR
- can obtain adequate TTE image in most mechanically ventilated patients
- information gathered can change management
- intensivists more readily available and can perform repeated examinations
- cardiologists not used to assessment of the critically ill (effect of therapeutic interventions, inotropes, fluid therapy, IABP)
- saving images allows review, audit, governance and quality control.
ARGUMENTS AGAINST
- steep learning curve (written assessment + a log book of 250 ECHO’s recommended by British Society of Echocardiography)
- requires structured training (just picking up probe can mean drawing wrong conclusions)
- cardiologists provide more comprehensive assessment
TYPES
(1) Trans-thoracic echo (TTE)
Advantages
- quick, easy
- non-invasive
- no contraindications
- no morbidity or mortality
- useful in seeing LV clot and pericardial effusion
Disadvantages
- limited windows in ventilated
- limited usefulness in endocarditis
(2) Transoesophageal echo (TOE)
Advantages
- minimal morbidity and mortality
- excellent images
- good in ventilated patients
- required in endocarditis and LA clot diagnosis
- very useful for pericardial effusion and LV function
- correlates well with PA catheter
- less invasive than PA catheter
- safe with diathermy
Disadvantages
- take more time
- requires sedation
- oesophageal pathology = contraindication
- bacteraemia
- ulcers
- aspiration
CONCLUSION
- ECHO allows improved assessment and management of unstable, critically ill patients
- essential tool for category I indications
- continued cardiology input essential to maintain safety
References and Links
- Briggs, J et al (2010) “Should echocardiography become a core skill for intensivists?” British Journal of Hospital Medicine, Vol 72(1) page 58
Critical Care
Compendium
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