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Echocardiography in critical care

Jacob J Glaser, Cassandra Cardarelli, Samuel Galvagno, Thomas M Scalea, Sarah B Murthi
BACKGROUND: Point-of-care ultrasound often includes cardiac ultrasound. It is commonly used to evaluate cardiac function in critically ill patients but lacks the specific quantitative anatomic assessment afforded by standard transthoracic echocardiography (TTE). We developed the Focused Rapid Echocardiographic Examination (FREE), a hybrid between a cardiac ultrasound and TTE that places an emphasis on cardiac function rather than anatomy. We hypothesized that data obtained from FREE correlate well with TTE while providing actionable information for clinical decision making...
November 2016: Journal of Trauma and Acute Care Surgery
Kanchi Muralidhar, Deepak Tempe, Yatin Mehta, Poonam Malhotra Kapoor, Chirojit Mukherjee, Thomas Koshy, Prabhat Tewari, Naman Shastri, Satyajeet Misra, Kumar Belani
During current medical care, perioperative transesophageal echocardiography (TEE) has become a vital component of patient management, especially in cardiac operating rooms and in critical care medicine. Information derived from echocardiography has an important bearing on the patient's outcome. The Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA) has promoted the use of TEE during routine clinical care of patients undergoing cardiac surgery. An important mission of IACTA is to oversee training and certify anesthesiologists in the perioperative and intensive care use of TEE...
October 2016: Annals of Cardiac Anaesthesia
Yonatan Y Greenstein, Ross Littauer, Mangala Narasimhan, Paul H Mayo, Seth J Koenig
BACKGROUND: Widespread use of critical care ultrasonography (CCUS) for the management of patients in the intensive care unit requires an effective training program. The effectiveness of national and regional CCUS training courses is not known. This study describes a national level, simulation-based, three day CCUS training program and evaluates its effectiveness. METHODS: Five consecutive CCUS courses, with a total of 363 people, were studied. The three day CCUS training program consisted of didactic lectures, ultrasonography interpretation sessions, and hands-on modules with live models...
September 16, 2016: Chest
John H Boyd, Demetrios Sirounis, Julien Maizel, Michel Slama
BACKGROUND: In critically ill patients at risk for organ failure, the administration of intravenous fluids has equal chances of resulting in benefit or harm. While the intent of intravenous fluid is to increase cardiac output and oxygen delivery, unwelcome results in those patients who do not increase their cardiac output are tissue edema, hypoxemia, and excess mortality. Here we briefly review bedside methods to assess fluid responsiveness, focusing upon the strengths and pitfalls of echocardiography in spontaneously breathing mechanically ventilated patients as a means to guide fluid management...
September 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
Anthony S McLean
Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied.In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available...
August 20, 2016: Critical Care: the Official Journal of the Critical Care Forum
Xiao-Jing Hu, Qu-Ming Zhao, Xiao-Jing Ma, Wei-Li Yan, Xiao-Ling Ge, Bing Jia, Fang Liu, Lin Wu, Ming Ye, Guo-Ying Huang
AIM: Limited data have been available regarding critical congenital heart disease (CHD) screening in neonatal intensive care unit (NICUs). This study evaluated the feasibility of screening for CHD by adding pulse oximetry (POX) to clinical evaluation in a NICU in Shanghai, China. METHODS: We screened 4128 eligible consecutive NICU admissions using POX plus clinical evaluation. Infants with positive screening results were then evaluated with echocardiography. Those with negative screening results were put under observation, and they also underwent echocardiography if their oxygen saturation fell below 95% on room air during hospitalisation...
November 2016: Acta Paediatrica
Philippe Vignon, Xavier Repessé, Antoine Vieillard-Baron, Eric Maury
Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome...
August 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
Micah R Whitson, Paul H Mayo
Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography...
August 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
Darren Klugman, John T Berger
OBJECTIVES: The following review will describe the use of focused cardiac ultrasound performed by noncardiologists and its role as an acute hemodynamic monitoring tool in pediatric cardiac critical care. DATA SOURCE: MEDLINE and PubMed. CONCLUSION: The use of focused cardiac ultrasound has grown tremendously over recent years, and is increasingly being performed and interpreted by intensivists, anesthesiologists, and emergency medicine physicians...
August 2016: Pediatric Critical Care Medicine
J Heiberg, D El-Ansary, D J Canty, A G Royse, C F Royse
Focused echocardiography is becoming a widely used tool to aid clinical assessment by anaesthetists and critical care physicians. At the present time, most physicians are not yet trained in focused echocardiography or believe that it may result in adverse outcomes by delaying, or otherwise interfering with, time-critical patient management. We performed a systematic review of electronic databases on the topic of focused echocardiography in anaesthesia and critical care. We found 18 full text articles, which consistently reported that focused echocardiography may be used to identify or exclude previously unrecognised or suspected cardiac abnormalities, resulting in frequent important changes to patient management...
September 2016: Anaesthesia
Ángel Augusto Pérez-Calatayud, Raúl Carrillo-Esper, Emilio Arch-Tirado
INTRODUCTION: Mechanical ventilation is a therapy for vital support used in a significant proportion of critically ill patients. The right time to successfully discontinue this therapy is a challenge for the intensive care specialist. For this reason it is still a subject for research. The echocardiographic evaluation of the diastolic dysfunction, the diaphragm, and the lung have become an invaluable tool for weaning from mechanical ventilation protocols, especially in patients with difficult or prolonged weaning from mechanical ventilation...
May 2016: Gaceta Médica de México
A Kersten
In caring for critically ill patients, a sophisticated approach to treating hemodynamic instability in acute circulatory failure is a major concern of modern critical care. Depending on the form of shock-distributive, cardiogenic, hypovolemic or obstructive, with the possibility of overlapping forms of shock-preload, afterload, cardiac output, and contractility are altered in various ways. Modern critical care uses hemodynamic monitoring and bedside echocardiography in addition to clinical evaluation to treat the underlying cause and sequelae of shock...
June 17, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
X T Wang, H Zhao, D W Liu, H M Zhang, Y Long, W Z Chai, Q Zhang
OBJECTIVE: The purpose of this study was to evaluate the significance of echocardiography for the prognosis of acute left cardiac dysfunction in critically ill patients. METHODS: A prospective cohort study was conducted in patients with acute left cardiac dysfunction in the Department of Critical Care Medicine, Peking Union Medical College Hospital from June 2013 to June 2014. Patients were divided into four groups according to the echocardiographic manifestation, including biventricular failure, left ventricular failure, coronary related segmental movement disorder, non-coronary related segmental movement disorder...
June 2016: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
Juhani Rossinen
FATE (Focus Assessed Transthoracic Echocardiography) echocardiography can be learned more quickly than extensive cardiologic examination. It is intended to be used in emergency situations as a qualitative examination to resolve the cardiogenic mechanism of circulatory insufficiency and possible hypovolemia. The procedure is worth utilizing as a dynamic method in the assessment of the response to fluid therapy and vasoactive medications. In many cases, however, a more profound ultrasound imaging will provide essential further information...
2016: Duodecim; Lääketieteellinen Aikakauskirja
Andrew J Inglis, Marek Nalos, Kwan-Hing Sue, Jan Hruby, Daniel M Campbell, Rachel M Braham, Sam R Orde
OBJECTIVE: To compare lung ultrasonography (LUS), chest xray (CXR) and physical examination (Ex) for the detection of pathological abnormalities in the lungs of critically ill patients. DESIGN, SETTING AND PARTICIPANTS: A prospective cohort study of 145 patients in the intensive care unit of a tertiary teaching hospital who were undergoing echocardiography for a clinical indication. MAIN OUTCOME MEASURES: Each patient was independently assessed by Ex, CXR and LUS on the same day...
June 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Laurent Guérin, Antoine Vieillard-Baron
Echocardiography is a noninvasive and accurate tool used in the intensive care unit to assess cardiac function and monitor hemodynamics in shocked patients. During severe sepsis or septic shock, several mechanisms can lead to hemodynamic failure and have to be quickly and precisely diagnosed to propose adequate, personalized, and timely hemodynamic therapy. Echocardiography truly provides intensivists with this diagnostic possibility, whether or not there is fluid responsiveness, cardiac dysfunction, or persistent vasoplegia...
June 2016: Clinics in Chest Medicine
Luca Longobardo, Christopher Kramer, Scipione Carerj, Concetta Zito, Renuka Jain, Valentin Suma, Vinay Thohan, Nasir Sulemanjee, Frank X Downey, Bijoy K Khandheria
The role of left ventricular assist devices (LVAD) in patients with end-stage heart failure is well known, both as a temporary treatment before transplantation and as destination therapy, in a scenario of a relative shortage of donors to satisfy the increasing requests for transplantation. The increased population of LVAD patients needs careful imaging assessment before, during, and after LVAD implantation; echocardiography is the best tool for their evaluation and is considered the diagnostic technique of choice for the assessment before, during, and after device implantation...
July 2016: Current Cardiology Reports
Vincent Labbé, Stéphane Ederhy, Blandine Pasquet, Romain Miguel-Montanes, Cédric Rafat, David Hajage, Stéphane Gaudry, Didier Dreyfuss, Ariel Cohen, Muriel Fartoukh, Jean-Damien Ricard
BACKGROUND: To evaluate the diagnostic performances of two training programs for residents with no prior ultrasound experience to reach competences in extended basic critical care transthoracic echocardiography (CCE) including Doppler capabilities. METHODS: This is a prospective observational study in two intensive care units of teaching hospitals. Group I (five residents) completed a short training program (4-h theory; 3-h practical); group II (six residents) completed a longer training program (6-h theory; 12-h practical)...
December 2016: Annals of Intensive Care
Bradford B Smith, Andrew S Nickels, Hans P Sviggum
A 75-year-old female presented for left total hip reimplantation and suffered pulseless electrical activity arrest upon lateral positioning and administering vancomycin. Resuscitation was achieved according to Advanced Cardiac Life Support protocol. Post-event echocardiography showed hypertrophic cardiomyopathy with asymmetrical septal thickening, an under-filled left ventricle, dynamic left ventricular outflow obstruction, and severe mitral regurgitation related to systolic anterior motion of the mitral valve...
June 2016: Journal of Clinical Anesthesia
Alexander Levitov, Heidi L Frankel, Michael Blaivas, Andrew W Kirkpatrick, Erik Su, David Evans, Douglas T Summerfield, Anthony Slonim, Raoul Breitkreutz, Susanna Price, Matthew McLaughlin, Paul E Marik, Mahmoud Elbarbary
OBJECTIVE: To establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites. METHODS: Grading of Recommendations, Assessment, Development and Evaluation system was used to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and to determine the "strength" of recommendations as either strong (strength class 1) or conditional/weak (strength class 2), thus generating six "grades" of recommendations (1A-1B-1C-2A-2B-2C)...
June 2016: Critical Care Medicine
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