Description
Bedside echocardiography (ECHO) and ultrasound play a crucial role in hemodynamic monitoring and management in the intensive care unit (ICU). They are non-invasive techniques, reducing the risks associated with invasive procedures while offering valuable insights into cardiac function. ECHO and ultrasound help evaluate intravascular volume, guiding the administration of fluids in critically ill patients to optimize cardiac output. These tools allow assessment of cardiac contractility, ejection fraction, and valvular function, aiding in the management of heart-related issues. ECHO and ultrasound are instrumental in diagnosing conditions like pericardial effusion, tamponade, cardiomyopathy, and structural heart defects in ICU patients. In some cases, ECHO and ultrasound can replace more invasive monitoring techniques, like pulmonary artery catheters, for hemodynamic data. They help monitor the effects of interventions, such as medication administration, fluid boluses, or mechanical ventilation adjustments. ECHO and ultrasound can guide procedures like central line placement, thoracentesis, or pericardiocentesis, reducing the risk of complications. ECHO and ultrasound allow evaluation of not only the heart but also other organs, including the lungs and abdomen, providing a comprehensive view of a patient's condition.
Résumé
- Echocardiography and ultrasound are valuable tools in the ICU for assessing and managing patients in shock. They aid in determining the type of shock (cardiogenic, hypovolemic, obstructive, septic) and guiding fluid and vasopressor management. Although not a standalone modality, they complement other clinical assessments.
- Inferior vena cava (IVC) diameter assessment, while commonly used, requires careful interpretation. It involves measuring the IVC at the subcostal four-chamber view using specific probes and modes (B-mode, M-mode). Indices like IVC collapsibility index, distensibility index, and delta IVC are calculated to assess fluid responsiveness. However, factors like diaphragm movement and IVC compliance should be considered.
- Left ventricular outflow tract velocity time integral (LVOT VTI) is another important parameter for hemodynamic assessment. It involves measuring the LVOT area and VTI to determine stroke volume. The procedure includes obtaining a parasternal long-axis view and apical five-chamber view, along with pulse wave Doppler measurements.
- Right heart assessment is crucial in cases of pulmonary embolism or pericardial tamponade. Echocardiography can help evaluate right ventricular size and function, including paradoxical septum motion and tricuspid annular plane systolic excursion (TAPSE). Specific signs like McConnell's sign and the 60/60 sign can aid in diagnosing pulmonary embolism.
- Lung ultrasound is a valuable tool for assessing pulmonary conditions using specific transducers and scanning techniques. It involves identifying artifacts like A-lines and B-lines, and assessing lung sliding to detect pneumothorax. The BLUE protocol guides lung ultrasound interpretation for patients with dyspnea, differentiating between various pulmonary pathologies.
- Fluid management decisions can be guided by protocols like the FALS protocol, which integrates ultrasound and echocardiography findings. The protocol aims to rule out obstructive shock, assess cardiogenic shock, and guide fluid resuscitation based on lung ultrasound findings. The passive leg raising test, combined with echocardiography, can assess fluid responsiveness by measuring LVOT VTI.
Exemple de certificat
À propos des intervenants
Dr Rishabh Kumar Mittal
Consultant principal en médecine de soins intensifs et responsable de l'unité de soins intensifs en gastro-entérologie et transplantation hépatique, hôpital Max Super Specialty, Delhi
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