Indications echocardiography
From Echocardiography in ICU
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...)
