Specific skill set and goals of focused echocardiography for critical care clinicians

Abstract

Echocardiography in the critical care setting can provide crucial information about the patient's cardiac anatomy, ejection fraction, valvular function, and volume status. There is a need for more involvement by intensivists in performing focused echocardiographic studies as this modality has been well shown to improve patient care. Several factors limit the widespread use of this technology by intensivists that are noncardiologists. One of them is the lack of formal didactic and practical training programs in "goal-directed" echocardiography specifically oriented for the critical care specialist. Although it is clear that extensive training and experience are needed to perform and interpret a complete echocardiographic study, a growing body of literature demonstrates that noncardiology medical professionals can be trained to acquire and interpret echocardiographic imaging in a goal-directed or "focused" manner with an acceptable overall level of accuracy. Performance of such focused echocardiography by intensivists has been shown to provide new information not assessable by physical examination, and often leads to change in therapeutic management at the bedside. Echocardiography using the transthoracic approach is a noninvasive imaging modality and is of great value in the critical care setting because of its portability, widespread availability, and rapid diagnostic capability. Programs for intensivists should cover both the transthoracic and transesophageal approach. Focused training with the transthoracic approach should be offered to all intensivists, while training with the transesophageal approach should be offered to intensivists who desire more advanced training. This article will go over important issues regarding current and potential avenues for training of critical care physicians in performance of focused bedside echocardiography.