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Editorial
. 2018 Feb 22;22(1):40.
doi: 10.1186/s13054-018-1970-8.

What is new in critical care echocardiography?

Philippe Vignon  1   2   3
Affiliations
Editorial

What is new in critical care echocardiography?

Philippe Vignon. Crit Care. .
No abstract available

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Conflict of interest statement

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Not applicable.

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Not applicable.

Competing interests

The author declares that he has no competing interests.

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Figures

Fig. 1
Fig. 1
Hemodynamic assessment using transesophageal echocardiography in two patients presenting with shock of distinct origin. In the first patient (left panels), inadequate cardiac output was ascribed to a persisting preload dependence, as reflected by concordant and significant respiratory variations (closed thick white arrow: mechanical insufflation) of the superior vena cava (SVC) diameter (upper left, collapsibility index), of the inferior vena cava (IVC; middle left, distensibility index), and of maximal Doppler velocity recorded in the left ventricular outflow tract (lower left, open thick arrow: expiration phase). In this patient, cardiac output significantly increased after fluid loading. In the second patient who was under protective mechanical ventilation for an acute respiratory distress syndrome (right panels) and exhibited tissue hypoperfusion, a 15% pulse pressure variation suggested fluid responsiveness. Transesophageal echocardiography disclosed an enlarged right ventricle (RV) in conjunction with a paradoxical septal motion consistent with an acute cor pulmonale (upper right, thin arrow) and significant respiratory variations of maximal Doppler velocity recorded in the left ventricular outflow tract (middle right, open thick arrow: expiration phase; closed thick arrow: mechanical insufflation). Nevertheless, the absence of any respiratory variations of the superior vena cava diameter suggested the absence of fluid responsiveness, but rather a systemic venous congestion associated with acute cor pulmonale (lower right). Accordingly, both pulse pressure variation and respiratory variations of maximal Doppler velocity recorded in the left ventricular outflow tract were interpreted as false-positive results. Blood volume expansion was considered potentially inefficient and detrimental, ventilator settings were modified, and inhaled nitric oxide was initiated to further unload the right ventricle. LV left ventricle
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References

    1. McLean AS. Echocardiography in shock management. Crit Care. 2016;20:275. doi: 10.1186/s13054-016-1401-7. - DOI - PMC - PubMed
    1. Orde S, Slama M, Hilton A, Yastrebov K, McLean AS. Pearls and pitfalls in comprehensive critical care echocardiography. Crit Care. 2017;21:279. doi: 10.1186/s13054-017-1866-z. - DOI - PMC - PubMed
    1. Yang Y, Royse C, Royse A, Williams K, Canty D. Survey of the training and use of echocardiography and lung ultrasound in Australasian intensive care units. Crit Care. 2016;20:339. doi: 10.1186/s13054-016-1444-9. - DOI - PMC - PubMed
    1. Prat G, Charron C, Repesse X, Coriat P, Bailly P, L'her E, Vieillard-Baron A. The use of computerized echocardiographic simulation improves the learning curve for transesophageal hemodynamic assessment in critically ill patients. Ann Intensive Care. 2016;6:27. doi: 10.1186/s13613-016-0132-x. - DOI - PMC - PubMed
    1. Boyd JH, Sirounis D, Maizel J, Slama M. Echocardiography as a guide for fluid management. Crit Care. 2016;20:274. doi: 10.1186/s13054-016-1407-1. - DOI - PMC - PubMed

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