Indications echocardiography

From Echocardiography in ICU

Revision as of 10:38, 26 October 2009 by Asberaud (Talk | contribs)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to: navigation, search

  


Contents

Advantages of echocardiography in critically ill patients:


Advantages of echo

Disadvantages of echo

Easy access, anytime and anyday
Realized at the bedside of the patient
Non-invasive
Real-time results and interpretation
Can be repeated as often as needed for monitoring
Useful for diagnosis, assessment and monitoring

Echogenicity compromised in intubated patients

Operator dependant, importance of training and experience+++


 

Indications for echocardiography in critically ill patients:

 

Estimation of volume status

Circulatory failure

      Etiology

          Tamponade

          Left ventricle dysfunction

          Severe valvulopathy

          Pulmonary embolism

     Hemodynamic assessment

     Monitoring

Respiratory distress

     Distinction between cardiogenic and lesional pulmonary edema

     Problems in weaning patients from the ventilator

Thoracic trauma

Chest pain

Cardiac arrest



Transthoracic (TTE) or transesophageal (TEE) approach?

When is TTE better?
  • For the evaluation of pericardial effusion: you will have a better estimation of the location and amount of effusion, a better overall view of the heart from the subcostal window
  • The left ventricle apex is better visualized from the transthoracic apical view (closer to the probe)
  • The inferior vena cava: IVC and sub-hepatic veins are useful for the estimation of the volume status, can not be visualized with TEE. With TEE, volume status is estimated from the superior vena cava (SVC) 
  • Doppler studies are better from transthoracic apical view: the Doppler beam alignment is optimal with mitral, triscupid and aortic flows in most of the patients
  • The left atrium can not be appreciated reliably with TEE


When is TEE better?
  • When very high quality images of structures close to the esophagus are needed: left atrium appendage, mitral valve
  • For suspicion of aortic dissection
  • For the evaluation of prosthetic mitral valves
  • When transthoracic images can not be obtained (emphysema, body habitus...)
Personal tools