Abstract:SummaryThis study was undertaken in order to elucidate the differences between various planes of measurement and Doppler techniques (pulsed-vs. continuous-wave Doppler) across the aortic valve to estimate cardiac output. In 45 coronary artery bypass patients, cardiac output was measured each time using four different Doppler techniques (transverse and longitudinal plane, pulsed-and continuous-wave Doppler) and compared with the thermodilution technique. Measurements were performed after induction of anaesthesi… Show more
“…Mitral and tricuspid valve issues can be captured by TOE with a combination of transverse and longitudinal planes in the multiplane facility. Assessment of aortic valve function is more difficult but possible using a deep transgastric view in a transverse plane (0°) in the stomach or a LAX view (120°) at the gastro--oesophageal transition [22]. This view, in fact, allows for the dynamic imaging of all four valves.…”
Over the past decades, ultrasound (US) has gained its place in the armamentarium of monitoring tools in the intensive care unit (ICU). Critical care ultrasonography (CCUS) is the combination of general CCUS (lung and pleural, abdominal, vascular) and CC echocardiography, allowing prompt assessment and diagnosis in combination with vascular access and therapeutic intervention. This review summarises the findings, challenges lessons from the 3 rd Course on Acute Care Ultrasound (CACU) held in November 2015, Antwerp, Belgium. It covers the different modalities of CCUS; touching on the various aspects of training, clinical benefits and potential benefits. Despite the benefits of CCUS, numerous challenges remain, including the delivery of CCUS training to future intensivists. Some of these are discussed along with potential solutions from a number of national European professional societies. There is a need for an international agreed consensus on what modalities are necessary and how best to deliver training in CCUS.
“…Mitral and tricuspid valve issues can be captured by TOE with a combination of transverse and longitudinal planes in the multiplane facility. Assessment of aortic valve function is more difficult but possible using a deep transgastric view in a transverse plane (0°) in the stomach or a LAX view (120°) at the gastro--oesophageal transition [22]. This view, in fact, allows for the dynamic imaging of all four valves.…”
Over the past decades, ultrasound (US) has gained its place in the armamentarium of monitoring tools in the intensive care unit (ICU). Critical care ultrasonography (CCUS) is the combination of general CCUS (lung and pleural, abdominal, vascular) and CC echocardiography, allowing prompt assessment and diagnosis in combination with vascular access and therapeutic intervention. This review summarises the findings, challenges lessons from the 3 rd Course on Acute Care Ultrasound (CACU) held in November 2015, Antwerp, Belgium. It covers the different modalities of CCUS; touching on the various aspects of training, clinical benefits and potential benefits. Despite the benefits of CCUS, numerous challenges remain, including the delivery of CCUS training to future intensivists. Some of these are discussed along with potential solutions from a number of national European professional societies. There is a need for an international agreed consensus on what modalities are necessary and how best to deliver training in CCUS.
“…Heart rate was determined from an electrocardiographic trace using the R-R interval between the first and last VTI. CO was calculated by multiplying the mean VTI by the mean AVA and heart rate [24][25][26]. To test intra-observer variability, measurements of CO by TEE were repeated twice by an echocardiographer.…”
These findings demonstrate that measuring CO using the thermodilution technique is less accurate in patients with moderate-to-severe TR and that the NICO monitor is more accurate for such patients. We postulate that the NICO monitor measures CO more accurately and reproducibly than thermodilution in patients with coexisting TR.
“…Stroke volume can be derived from the area under the curve of a transaortic valvular Doppler signal (velocity time integral, VTI), obtained in a deep transgastric view [35,36]. VTI is actually the distance at which one red blood cell is pushed with a single contraction of the left ventricle.…”
Optimization of the preloading conditions and concomitant determination of endpoints of fluid administration are the most frequent therapeutic actions in critically ill patients. Besides a clinical appraisal, reproducible data should be acquired at the bedside to estimate the adequacy of fluid resuscitation. The dynamic assessment and determination of fluid responsiveness plays a major role in this respect. Right-sided cardiac variables, such as inferior and superior caval vein diameter variation during mechanical ventilation, are easily obtained with cardiac ultrasound. Moreover, left sided variables, including aortic flow variation, with intermittent swings of intrathoracic pressure during mechanical ventilation, may be achieved non-invasively with Doppler-echocardiography. Both in terms of resuscitation, as well as correct interpretation of various two-dimensional and Doppler variables, it is essential to acquire a clear understanding of the filling status of a patient. Doppler-echocardiography plays herein a pivotal role.
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