Skip to main content
SpringerLink
Log in

Focused Cardiac Ultrasound in the CT ICU: Helpful or Just Another Toy?

  • Chapter
  • First Online:
Difficult Decisions in Cardiothoracic Critical Care Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

  • 970 Accesses

Abstract

Cardiac imaging in the cardiothoracic intensive care unit (CTICU) plays an important role in the pre- and postoperative management of patients. While echocardiography is the primary imaging tool used, comprehensive examinations performed by a sonographer and interpreted by a cardiologist may not be available when assessment is required urgently or frequently. Focused cardiac ultrasound (FCU) is an ultrasound examination performed and interpreted at the bedside by a non-cardiologist to evaluate for a defined list of diagnoses. Several subspecialties have shown the value of using FCU in conjunction with physical exam and monitoring devices to guide patient assessment and management. This chapter will address the use of FCU in critically ill patients, with a focus on the CTICU.

†(Deceased)

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Schleder S, Dittmar M, Poschenrieder F, Dornia C, Schmid C, Rennert J, Stroszczynski C, Jung EM, Heiss P. Diagnosis of pericardial effusion with a new generation hand-carried ultrasound device in cardiothoracic intensive care unit patients. Acta Radiol. 2012;53:1133–6.

    Article  CAS  Google Scholar 

  2. Sobczyk D, Nycz K, Andruszkiewicz P. Bedside ultrasonographic measurement of the inferior vena cava fails to predict fluid responsiveness in the first 6 hours after cardiac surgery: a prospective case series observational study. J Cardiothorac Vasc Anesth. 2015;29:663–9.

    Article  Google Scholar 

  3. Sekiguchi H, Harada Y, Villarraga HR, Mankad SV, Gajic O. Focused cardiac ultrasound in the early resuscitation of severe sepsis and septic shock: a prospective pilot study. J Anesth. 2017;31:487–93.

    Article  Google Scholar 

  4. De Lorenzo RA, Morris MJ, Williams JB, Haley TF, Straight TM, Holbrook-Emmons VL, Medina JS. Does a simple bedside sonographic measurement of the inferior vena cava correlate to central venous pressure? J Emerg Med. 2012;42:429–36.

    Article  Google Scholar 

  5. Kanji HD, McCallum J, Sirounis D, MacRedmond R, Moss R, Boyd JH. Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. J Crit Care. 2014;29:700–5.

    Article  Google Scholar 

  6. Manno E, Navarra M, Faccio L, Motevallian M, Bertolaccini L, Mfochive A, Pesce M, Evangelista A. Deep impact of ultrasound in the intensive care unit: the “ICU-sound” protocol. Anesthesiology. 2012;117:801–9.

    Article  Google Scholar 

  7. Michalski B, Kasprzak JD, Szymczyk E, Lipiec P. Diagnostic utility and clinical usefulness of the pocket echocardiographic device. Echocardiography. 2012;29:1–6.

    Article  Google Scholar 

  8. Oks M, Cleven KL, Cardenas-Garcia J, Schaub JA, Koenig S, Cohen RI, Mayo PH, Narasimhan M. The effect of point-of-care ultrasonography on imaging studies in the medical ICU: a comparative study. Chest. 2014;146:1574–7.

    Article  Google Scholar 

  9. Zieleskiewicz L, Muller L, Lakhal K, Meresse Z, Arbelot C, Bertrand P-M, Bouhemad B, Cholley B, Demory D, Duperret S, Duranteau J, Guervilly C, Hammad E, Ichai C, Jaber S, Langeron O, Lefrant J-Y, Mahjoub Y, Maury E, Meaudre E, Michel F, Muller M, Nafati C, Perbet S, Quintard H, Riu B, Vigne C, Chaumoitre K, Antonini F, Allaouchiche B, Martin C, Constantin J-M, De Backer D, Leone M, Car’Echo, AzuRea Collaborative N. Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med. 2015;41:1638–47.

    Article  Google Scholar 

  10. Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26:567–81.

    Article  Google Scholar 

  11. Via G, Hussain A, Wells M, Reardon R, ElBarbary M, Noble VE, Tsung JW, Neskovic AN, Price S, Oren-Grinberg A, Liteplo A, Cordioli R, Naqvi N, Rola P, Poelaert J, Gulic TG, Sloth E, Labovitz A, Kimura B, Breitkreutz R, Masani N, Bowra J, Talmor D, Guarracino F, Goudie A, Xiaoting W, Chawla R, Galderisi M, Blaivas M, Petrovic T, Storti E, Neri L, Melniker L, International Liaison Committee on Focused Cardiac U, International Conference on Focused Cardiac U. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014;27:683.e681–33.

    Article  Google Scholar 

  12. Chisholm CB, Dodge WR, Balise RR, Williams SR, Gharahbaghian L, Beraud A-S. Focused cardiac ultrasound training: how much is enough? J Emerg Med. 2013;44:818–22.

    Article  Google Scholar 

  13. Townsend NT, Kendall J, Barnett C, Robinson T. An effective curriculum for focused assessment diagnostic echocardiography: establishing the learning curve in surgical residents. J Surg Educ. 2016;73:190–6.

    Article  Google Scholar 

  14. Mark DG, Ku BS, Carr BG, Everett WW, Okusanya O, Horan A, Gracias VH, Dean AJ. Directed bedside transthoracic echocardiography: preferred cardiac window for left ventricular ejection fraction estimation in critically ill patients. Am J Emerg Med. 2007;25:894–900.

    Article  Google Scholar 

  15. Martin LD, Howell EE, Ziegelstein RC, Martire C, Shapiro EP, Hellmann DB. Hospitalist performance of cardiac hand-carried ultrasound after focused training. Am J Med. 2007;120:1000–4.

    Article  Google Scholar 

  16. Narula J, Chandrashekhar Y, Braunwald E. Time to add a fifth pillar to bedside physical examination: inspection, palpation, percussion, auscultation, and insonation. JAMA Cardiol. 2018. https://doi.org/10.1001/jamacardio.2018.0001. Published online February 28, 2018.

    Article  Google Scholar 

  17. Joseph MX, Disney PJS, Da Costa R, Hutchison SJ. Transthoracic echocardiography to identify or exclude cardiac cause of shock. Chest. 2004;126:1592–7.

    Article  Google Scholar 

  18. Marcelino PA, Marum SM, Fernandes APM, Germano N, Lopes MG. Routine transthoracic echocardiography in a general Intensive Care Unit: an 18 month survey in 704 patients. Eur J Intern Med. 2009;20:E37–42.

    Article  Google Scholar 

  19. Stanko LK, Jacobsohn E, Tam JW, De Wet CJ, Avidan M. Transthoracic echocardiography: impact on diagnosis and management in tertiary care intensive care units. Anaesth Intensive Care. 2005;33:492–6.

    Article  CAS  Google Scholar 

  20. Bossone E, DiGiovine B, Watts S, Marcovitz PA, Carey L, Watts C, Armstrong WF. Range and prevalence of cardiac abnormalities in patients hospitalized in a medical ICU. Chest. 2002;122:1370–6.

    Article  Google Scholar 

  21. Manasia AR, Nagaraj HM, Kodali RB, Croft LB, Oropello JM, Kohli-Seth R, Leibowitz AB, DelGiudice R, Hufanda JF, Benjamin E, Goldman ME. Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients. J Cardiothorac Vasc Anesth. 2005;19:155–9.

    Article  Google Scholar 

  22. Killu K, Coba V, Mendez M, Reddy S, Adrzejewski T, Huang Y, Ede J, Horst M. Model point-of-care ultrasound curriculum in an intensive care unit fellowship program and its impact on patient management. Crit Care Res Pract. 2014;2014:934796.

    PubMed  PubMed Central  Google Scholar 

  23. Vignon P, Dugard A, Abraham J, Belcour D, Gondran G, Pepino F, Marin B, Francois B, Gastinne H. Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit. Intensive Care Med. 2007;33:1795–9.

    Article  Google Scholar 

  24. Hulett CS, Pathak V, Katz JN, Montgomery SP, Chang LH. Development and preliminary assessment of a critical care ultrasound course in an adult pulmonary and critical care fellowship program. Ann Am Thorac Soc. 2014;11:784–8.

    Article  Google Scholar 

  25. See KC, Ong V, Ng J, Tan RA, Phua J. Basic critical care echocardiography by pulmonary fellows: learning trajectory and prognostic impact using a minimally resourced training model. Crit Care Med. 2014;42:2169–77.

    Article  Google Scholar 

  26. Gunst M, Matsushima K, Sperry J, Ghaemmaghami V, Robinson M, O'Keeffe T, Friese R, Frankel H. Focused bedside echocardiography in the surgical intensive care unit: comparison of 3 methods to estimate cardiac index. J Intensive Care Med. 2011;26:255–60.

    Article  Google Scholar 

  27. Melamed R, Sprenkle MD, Ulstad VK, Herzog CA, Leatherman JW. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest. 2009;135:1416–20.

    Article  Google Scholar 

  28. Mark DG, Hayden GE, Ky B, Paszczuk A, Pugh M, Matthews S, Horan A, Gracias VH, Kirkpatrick JN, Dean AJ. Hand-carried echocardiography for assessment of left ventricular filling and ejection fraction in the surgical intensive care unit. J Crit Care. 2009;24:470.e471–7.

    Article  Google Scholar 

  29. Carr BG, Dean AJ, Everett WW, Ku BS, Mark DG, Okusanya O, Horan AD, Gracias VH. Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study. J Trauma Inj Infect Crit Care. 2007;63:495–500; discussion 500–492.

    Article  Google Scholar 

  30. Vignon P, Mucke F, Bellec F, Marin B, Croce J, Brouqui T, Palobart C, Senges P, Truffy C, Wachmann A, Dugard A, Amiel J-B. Basic critical care echocardiography: validation of a curriculum dedicated to noncardiologist residents. Crit Care Med. 2011;39:636–42.

    Article  Google Scholar 

  31. Razi R, Estrada JR, Doll J, Spencer KT. Bedside hand-carried ultrasound by internal medicine residents versus traditional clinical assessment for the identification of systolic dysfunction in patients admitted with decompensated heart failure. J Am Soc Echocardiogr. 2011;24:1319–24.

    Article  Google Scholar 

  32. Johnson BK, Tierney DM, Rosborough TK, Harris KM, Newell MC. Internal medicine point-of-care ultrasound assessment of left ventricular function correlates with formal echocardiography. J Clin Ultrasound. 2016;44:92–9.

    Article  Google Scholar 

  33. Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, Brooks E, Levy A, Kirkpatrick JN, Spencer KT. A comparison by medicine residents of physical examination versus hand-carried ultrasound for estimation of right atrial pressure. Am J Cardiol. 2007;99:1614–6.

    Article  Google Scholar 

  34. Gunst M, Ghaemmaghami V, Sperry J, Robinson M, O’Keeffe T, Friese R, Frankel H. Accuracy of cardiac function and volume status estimates using the bedside echocardiographic assessment in trauma/critical care. J Trauma Inj Infect Crit Care. 2008;65:509–16.

    Article  Google Scholar 

  35. Stawicki SP, Braslow BM, Panebianco NL, Kirkpatrick JN, Gracias VH, Hayden GE, Dean AJ. Intensivist use of hand-carried ultrasonography to measure IVC collapsibility in estimating intravascular volume status: correlations with CVP. J Am Coll Surg. 2009;209:55–61.

    Article  Google Scholar 

  36. Prekker ME, Scott NL, Hart D, Sprenkle MD, Leatherman JW. Point-of-care ultrasound to estimate central venous pressure: a comparison of three techniques. Crit Care Med. 2013;41:833–41.

    Article  Google Scholar 

  37. Beraud A-S, Rizk NW, Pearl RG, Liang DH, Patterson AJ. Focused transthoracic echocardiography during critical care medicine training: curriculum implementation and evaluation of proficiency*. Crit Care Med. 2013;41:e179–81.

    Article  Google Scholar 

  38. Gunst M, Sperry J, Ghaemmaghami V, O’Keeffe T, Friese R, Frankel H. Bedside echocardiographic assessment for trauma/critical care: the BEAT exam. J Am Coll Surg. 2008;207:e1–3.

    Article  Google Scholar 

  39. Mosier JM, Malo J, Stolz LA, Bloom JW, Reyes NA, Snyder LS, Adhikari S. Critical care ultrasound training: a survey of US fellowship directors. J Crit Care. 2014;29:645–9.

    Article  Google Scholar 

  40. Kanji HD, McCallum JL, Bhagirath KM, Neitzel AS. Curriculum development and evaluation of a hemodynamic critical care ultrasound: a systematic review of the literature. Crit Care Med. 2016;44:e742–50.

    Article  Google Scholar 

  41. Amini R, Stolz LA, Javedani PP, Gaskin K, Baker N, Ng V, Adhikari S. Point-of-care echocardiography in simulation-based education and assessment. Adv Med Educ Pract. 2016;7:325–8.

    Article  Google Scholar 

  42. Skinner AA, Freeman RV, Sheehan FH. Quantitative feedback facilitates acquisition of skills in focused cardiac ultrasound. Simul Healthc J Soc Med Simul. 2016;11:134–8.

    Article  Google Scholar 

  43. Jozwiak M, Monnet X, Cinotti R, Bontemps F, Reignier J, Belliard G. Prospective assessment of a score for assessing basic critical-care transthoracic echocardiography skills in ventilated critically ill patients. Ann Intensive Care. 2014;4:12.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Chicago, Chicago, IL, USA

    Kirk T. Spencer†

Authors
  1. Kirk T. Spencer†
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kirk T. Spencer† .

Editor information

Editors and Affiliations

  1. University of Chicago Medicine, Chicago, IL, USA

    Vassyl A. Lonchyna

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Spencer†, K.T. (2019). Focused Cardiac Ultrasound in the CT ICU: Helpful or Just Another Toy?. In: Lonchyna, V. (eds) Difficult Decisions in Cardiothoracic Critical Care Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-04146-5_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-04146-5_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-04145-8

  • Online ISBN: 978-3-030-04146-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation