Clinician-performed ultrasound in hemodynamic and cardiac assessment: a synopsis of current indications and limitations

Abstract

Accurate hemodynamic and intravascular volume status assessment is essential in the diagnostic and therapeutic management of critically ill patients. Over the last two decades, a number of technological advances were translated into a variety of minimally invasive or non-invasive hemodynamic monitoring modalities. Despite the promise of less invasive technologies, the quality, reliability, reproducibility, and generalizability of resultant hemodynamic and intravascular volume status data have been lacking. Since its formal introduction, ultrasound technology has provided the medical community with a more standardized, higher quality, broadly applicable, and reproducible method of accomplishing the above-mentioned objectives. With the advent of portable, hand-carried devices, the importance of sonography in hemodynamic and volume status assessment became clear. From basic venous collapsibility and global cardiac assessment to more complex tasks such as the assessment of cardiac flow and tissue Doppler signals, the number of real-life indications for sonology continues to increase. This review will provide an outline of the essential ultrasound applications in hemodynamic and volume status assessment, focusing on evidence-based uses and indications.

Correlations between pulmonary artery pressures and inferior vena cava collapsibility in critically ill surgical patients: An exploratory study

“…[22] Intensivist–performed focused bedside sonographic assessment of intravascular volume status is increasing in popularity due to its relative simplicity, skill standardization, and mounting evidence of clinical utility. [910121322232425] Given these parallel developments, as well as the need for more evidence–based comparative research, we set out to examine the relationship between IVC-CI and PAPs in a modest sample of patients.…”

Assessment of hypovolaemia in the critically ill

“…However, it is operator-dependent and measures should be taken to minimize inter-observer variability. Ultrasound has grown to be an important clinical tool for practicing intensivists and emergency physicians [26][27][28][29].…”

Keys to successful organ procurement: An experience-based review of clinical practices at a high-performing health-care organization

“…Any untoward clinical events, such as hypoxia or hypotension, should be primarily prevented or promptly addressed before end-organ damage occurs. Invasive central venous catheters, sonography-based hemodynamic assessments[23242526] as well as other methods of noninvasive hemodynamic monitoring[272829] should be employed liberally when appropriate clinical indications are present for their deployment.…”

“…[35] Intensivist presence facilitates the performance of advanced bedside procedures to assist in organ optimization and allocation such as echocardiography, bronchoscopy, central venous hemodynamic monitoring, or transesophageal echocardiography. [262836373839] Not only are our intensivists available 24 h a day to assist in procedures and critical decision-making but also their presence is vital as they provide support for the families and hospital staff.…”