Abstract
Using the focused rapid echocardiographic evaluation (FREE) is easier than explaining it. Below are examples of guiding complex resuscitation tailored to patient need with ultrasound. The scenarios are adapted from clinical cases using FREEs to direct management. Even though measurements contained in the FREE evolve, changing from time to time, the structure remains the same; patient assessment, selection of a fluid strategy, ultrasound evaluation of cardiac function, volume status, vascular resistance, and anatomic findings are used to generate recommendations about the use of fluid, vasopressors, and inotropic support.
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Abbreviations
- BP:
-
Blood pressure
- BSA:
-
Body surface area
- CI:
-
Cardiac index
- CRRT :
-
Continuous renal replacement therapy
- FREE:
-
Focused rapid echocardiographic evaluation
- HR:
-
Heart rate
- Ht:
-
Height
- ICU:
-
Intensive care unit
- IVC:
-
Inferior vena cava
- LVOT D:
-
Left ventricular outflow tract diameter
- MAP:
-
Mean arterial blood pressure
- PAC:
-
Pulmonary artery catheter
- PASP:
-
Pulmonary artery systolic pressure
- PEEP :
-
Positive end expiratory pressure
- POCUS:
-
Point-of-care ultrasound
- SVI:
-
Stroke volume index
- SVR:
-
Systemic vascular resistance
- SVV:
-
Stroke volume variation
- TAPSE:
-
Transannular plane systolic excursion
- UTA:
-
Unable to assess
- VR:
-
Volume responsiveness
- VTI:
-
Velocity time integral
- Wt:
-
Weight
Suggested Reading
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Murthi SB, Hess JR, Hess A, Stansbury LG, Scalea TM. Focused rapid echocardiographic evaluation versus vascular cather-based assessment of cardiac output and function in critically ill trauma patients. J Trauma Acute Care Surg. 2012;72(5):1158–64. https://doi.org/10.1097/TA.0b013e31824d1112. PMID: 22673240. PMID: 27768664
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Olivieri PP, Patel R, Kolb S, Fatima S, Galvagno SM, Haase DJ, et al. Echo is a good, not perfect, measure of cardiac output in critically ill surgical patients. J Trauma Acute Care Surg. 2019;87(2):379–85. https://doi.org/10.1097/TA.0000000000002304. PMID: 31349350
Spiegel R, Teeter W, Sullivan S, Tupchong K, Mohammed N, Sutherland M, et al. The use of venous Doppler to predict adverse kidney events in a general ICU cohort. Crit Care. 2020;24(1):615. https://doi.org/10.1186/s13054-020-03330-6. PMID: 33076961; PMCID: PMC7574322
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Murthi, S.B. (2021). The Focused Rapid Echocardiographic Evaluation (FREE): Clinical Examples. In: Salerno, A., Haase, D.J., Murthi, S.B. (eds) Atlas of Critical Care Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-030-74687-2_27
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DOI: https://doi.org/10.1007/978-3-030-74687-2_27
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