Bedside assessment of myocardial performance in the critically ill

Abstract

No measurement of myocardial performance currently available in the ICU can be regarded is ideal. Table 2 summarises the main features of the major monitoring techniques. As many of the indices of myocardial performance are interdependent, quantifying the contribution of each component to overall cardiac function is not possible currently, and the clinical utility of monitoring each individually is not therefore established. Bedside measurements of LV dimensions, volumes and ejection fraction, and the other indices of systolic and diastolic function can now be made, but the case for their routine use in influencing clinical practice remains unproven. Transoesophageal echocardiography has an important and established diagnostic role and has been used successfully for continuous monitoring during surgery, but practical considerations seriously limit its potential for routine use. Radionuclide techniques allow the measurement of many of the same parameters and have the potential for continuous use, but practical problems and the additional risk of radiation exposure may limit this application in the critical care environment. Doppler techniques are non-invasive, provide continuous data and are simple to operate, but the data provided has important limitations. Although the pulmonary artery catheter has been in use for over twenty years, questions regarding the information is provides concerning myocardial function remain and the extent to which it should influence therapeutic decisions is still controversial. However with the development of additional facilities, particularly the continuous measurement of cardiac output the pulmonary artery catheter seems likely to remain the mainstay of bedside monitoring of myocardial performance in the critically ill in the immediate future.

Monitoring cardiac function in intensive care

“…19 Unfortunately, no such technique exists for CO measurement in either paediatric or adult practice; thus the choice of method may vary depending on the patient and the clinical situation. A detailed description of all techniques available for CO measurement is beyond the scope of this article and is available elsewhere.…”

Life-threatening heart failure in meningococcal septic shock in children: non-invasive measurement of cardiac parameters is of important prognostic value

“…Therefore quantitative assessment of cardiac parameters such as left ventricle (LV) dimensions, volumes and ejection fraction can be used as guidelines in decision-making during treatment [39]. In patients in shock, ultrasonography permits rapid assessment of valvular structure and movement, the presence or absence of pericardial¯uid, and global and regional LV wall motion and cardiac chamber sizes [10].…”

TEE in Anästhesie und Intensivmedizin

“…Die zweifelhafte In-Durch den Einsatz der transösophagealen Echokardiographie (TEE) erlangte die Diagnostik der modernen klinischen Anästhesie und Intensivmedizin eine neue Dimension [9,25,36,54,86,89,115]. Durch die direkte Visualisierung des Herzens und herznaher Strukturen gewinnt der Untersucher ,Online'-Informationen über Herzfunktion, Füllungszustand und pathologische Strukturen im Thorax [58,103]. Gegenüber dem pulmonalarteriellen Katheter, dem derzeitigen Standardmonitoring der Herzkreislauffunktion, zeichnet sich die Echokardiographie durch einen kontinuierlichen Informationsfluß und eine geringere Invasivität aus.…”

“…Durch die direkte Visualisierung des Herzens und herznaher Strukturen gewinnt der Untersucher ,Online'-Informationen über Herzfunktion, Füllungszustand und pathologische Strukturen im Thorax [58,103]. Sie liefert insbesondere bei kritisch kranken Patienten einen wesentlichen Beitrag zur Diagnosefindung und Therapie [42,49,84,103,116]. Sie liefert insbesondere bei kritisch kranken Patienten einen wesentlichen Beitrag zur Diagnosefindung und Therapie [42,49,84,103,116].…”