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Review
. 2011 Aug;7(3):146-56.
doi: 10.2174/157340311798220485.

Echocardiographic hemodynamic monitoring in the critically ill patient

Francisco J Romero-Bermejo  1 , Manuel Ruiz-Bailen, Manuel Guerrero-De-Mier, Julian Lopez-Alvaro
Affiliations
Review

Echocardiographic hemodynamic monitoring in the critically ill patient

Francisco J Romero-Bermejo et al. Curr Cardiol Rev. 2011 Aug.

Abstract

Echocardiography has shown to be an essential diagnostic tool in the critically ill patient's assessment. In this scenario the initial fluid therapy, such as it is recommended in the actual clinical guidelines, not always provides the desired results and maintains a considerable incidence of cardiorrespiratory insufficiency. Echocardiography can council us on these patients' clinical handling, not only the initial fluid therapy but also on the best-suited election of the vasoactive/ inotropic treatment and the early detection of complications. It contributes as well to improving the etiological diagnosis, allowing one to know the heart performance with more precision. The objective of this manuscript is to review the more important parameters that can assist the intensivist in theragnosis of hemodynamically unstable patients.

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Figures

Image 1
Image 1
Severe pericardial effusion in subcostal transthoracic view.
Image 2
Image 2
Patient in shock state, with high suspicion of septic shock due to cholecystitis (fever, right hypochondrium pain). In the transesophageal study we found a giant thrombi in the right pulmonary artery (RPA). A) TEE for 30°. B) TEE for 120°.
Image 3
Image 3
ICV collapsibility index calculation in a patient with urological severe sepsis. Applying the equation: [(maximum diameter - minimum diameter) / maximum diameter] x 100, we get a rate of 21.4%, which suggests the need to start with vasoactive treatment.
Image 4
Image 4
Stroke volume maximum velocity determination (pulsed Doppler in LVOT). This image was collected immediately after a load of 500 cc of 0.9% Saline in a patient with septic shock of biliary tract origin. There was no evidence of significant variability compared to basal imaging, suggesting the need for vasoactive treatment.
Image 5A-5B
Image 5A-5B
Third degree diastolic dysfunction (restrictive pattern). Transmitral pulsed Doppler (4) and Doppler Tissue Imaging (B). E/E´ ratio was 20.
Image 6A-6B-6C
Image 6A-6B-6C
E/E´ratio. (A) Normal, (B) elevated, (C) E/E´ estimation with advanced echocardiographic software.
Image 7
Image 7
Color M-mode Doppler flow propagation velocity.
Image 8
Image 8
Diastolic function study: Pulsed Doppler in pulmonary veins. A) TEE image, B) TTE image. In both, systolic wave < diastolic wave.
Image 9
Image 9
E-interventricular septum distance.
Image 10
Image 10
Mitral Annular Plane Systolic Excursion. A) Normal, B) Severe systolic dysfunction.
Image 11A-11B
Image 11A-11B
Stroke volume calculus. Applying the continuity equation SV = π x R² x VTILVOT, SV = 3.1415 x 0.95 cm² x 20.8 cm = 59 ml.
Image 12
Image 12
VTI in LVOT in a patient with cardiogenic shock.
Image 13
Image 13
TAPSE. A) Normal, B) RV systolic dysfunction.
Image 14
Image 14
Pressure gradient between RV and right atria in a severe pulmonary hypertension.
Image 15
Image 15
Mean pulmonary artery pressure estimation. (ACt = Aceleration Time).
Image 16
Image 16
New echocardiographic techniques. A) Advanced DTI, B) Speckle tracking.
See this image and copyright information in PMC

References

    1. Ruiz-Bailén M, Romero-Bermejo FJ, Ramos-Cuadra J, et al. Evaluation of the performance of echocardiography in acute coronary syndrome patients during their stay in coronary units. Acute Card Care. 2011;13(1):21–9. - PubMed
    1. Vieillard-Baron A, et al. Echocardiography in the intensive care unit: from evolution to revolution? Intensive Care Med. 2008;34:243–249. - PubMed
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    1. Benjamin E, et al. Goal-directed transesophageal echocardiography performed by intensivists to assess left ventricular function: comparison with pulmonary artery catheterization. J Cardiothorac Vasc Anesth. 1998;12(1):10–15. - PubMed
    1. Manasia AR, et al. Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients. J Cardiothorac Vasc Anesth. 2005;19(2):155–9. - PubMed

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