Echocardiography in the intensive care unit: an essential tool for diagnosis, monitoring and guiding clinical decision-making

Abstract

In the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac diseases such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been increasing use of positive pressure mechanical ventilation which has its implications on the heart. Therefore, there is a growing need for Cardiac intensivists to quickly, noninvasively and repeatedly evaluate various hemodynamic conditions and the response to therapy.Transthoracic critical care echocardiography (CCE) currently represents an essential tool in CICU, as it is used to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular pathologies, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with trans-oesophageal echocardiography (TOE), advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making.

Efficacy of Continuous Renal Replacement Therapy and Intermittent Hemodialysis in Patients with Renal Failure in Intensive Care Unit: A Systemic Review and Meta‐analysis

“…ICU is a place where modern medical theory and high-tech modern equipment were applied to conduct specialized and centralized monitoring, treatment, and nursing for critically ill patients [ 34 ]. Most of the patients in the ICU are in serious disease conditions.…”

“…Our pooled results showed that CRRT showed similar efcacy in improving renal function and short-term mortality in patients with renal failure, further confrming the important role of CRRT in the treatment of renal impairment. ICU is a place where modern medical theory and high-tech modern equipment were applied to conduct specialized and centralized monitoring, treatment, and nursing for critically ill patients [34]. Most of the patients in the ICU are in serious disease conditions.…”

Bedside Ultrasound for Hemodynamic Monitoring in Cardiac Intensive Care Unit

“…First of all, perfusion can be evaluated through LV Ejection Fraction (EF), but it is well known that this parameter is greatly influenced by LV geometry, heart rate and loading conditions (preload and afterload). As a result of that, its usefulness is limited in critically ill patients [2]. Hence, in severe shock states, the estimation of CO, measured as a calculation of stroke volume (SV) times the heart rate, is a more reliable quantitative parameter as it truly reflects circulatory status and organ perfusion [9].…”

“…Normal LVOT VTI is higher than 18 cm and it could be used as a surrogate for SV, which is also an important predictor of fluid responsiveness. In particular, there are static measures of fluid responsiveness (inferior vena cava (IVC) diameter, CI and left ventricular enddiastolic area (LVEDA)) and dynamic measures (IVC distensibility in spontaneous breath and LVOT VTI respiratory variability) [2,7,10].…”

“…In these patients with signs of hemodynamic instability, echocardiography is the most reliable bedside method to assess cardiac function repeatedly, assisting clinicians not only in characterizing hemodynamic disorders, but also in helping to guide interventions and monitor response to therapies (such as intravenous fluids, inotropes, and ultrafiltration). Standard echocardiographic evaluation should rapidly provide sufficient information to confirm/exclude tamponade, mechanical complications of acute myocardial infarction (AMI), left ventricular (LV) outflow tract obstruction (LVOTO), severe valvular lesions and LV and right ventricular (RV) dysfunction [1][2][3].…”