Ecocardiografía en la Unidad de Cuidados Intensivos

Abstract

The echocardiography can provide important and relevant information and the critically ill patient presents a challenge for the echocardiographer: from limitations in image acquisition to interpretation in the context of rapid physiological and intervention changes. The most frequent reason for requesting an echocardiogram in the ICU is probably to assess left ventricular function. In any case, information of direct relevance for clinical management can in relationship to abnormalities of structure and function can be obtained and used to estimate pulmonary arterial and venous pressures. It can help to investigate the consequences of myocardial ischemia, valvular dysfunction and pericardial disease and detect changes characteristic of specific conditions (e.g. sepsis, pulmonary thromboembolism), although this must be interpreted in the context of each individual patient. The echocardiography also can be used to monitor the therapeutic interventions. The applications of echocardiography in the critical care setting are reviewed, with special emphasis on the assessment of cardiac physiology.

Endocarditis infecciosa en la Unidad de Medicina Intensiva

“…Es más, el número de casos puede estar infradiagnosticado y en ese sentido la ampliación de realización de ecocardiogramas transtorácicos y sobre todo transesofágicos en pacientes con sepsis podría resultar de gran utilidad 13 . En nuestro hospital, más de una tercera parte de los pacientes con diagnóstico de endocarditis en un periodo mayor de 6 años fue atendido en la UMI por diferentes causas, fundamentalmente sepsis e insuficiencia cardiaca graves complicados o no con shock.…”

Infectious endocarditis in the intensive care unit

“…Furthermore, the number of cases may be underdiagnosed, and in this sense an increased use of transthoracic echocardiography and especially of transesophageal echocardiography in patients with sepsis could prove very useful. 13 In our hospital, over one-third of the patients diagnosed with endocarditis during a period of 6 years were admitted to the ICU due to different causes---fundamentally severe sepsis and heart failure complicated or not with shock. The difference in the severity scores between the patients with and without admission to Intensive Care, and the increase in such scores from patient arrival in hospital, objectively reflect the clinical and hemodynamic worsening of the patients, as evidenced by their high morbiditymortality and the frequent indication of emergency surgery.…”

Echocardiography Practice: Insights into Appropriate Clinical Use, Technical Competence and Quality Improvement Program

“…In this perspective, we estimate that the time interval from ordering until achievement of the echocardiography study is critical and should be adapted to the clinical setting. Accordingly, we estimate that patients may belong to one of these three groups: 1) Urgent group, ie, mandatory echo in critically ill patients to assess hemodynamic condition for a tailored management to rule in/out a cardiogenic cause of a shock status (“do or die”); 2) Necessary group, ie, recommended echo before any cardiac interventional procedure (coronary angiogram, pacemaker implantation), or before initiation of some medications (such as beta blockers in patients suspected to have systolic dysfunction), or as pre-operative assessment in patients with cardiac morbidity or in patients for whom the operative procedure is considered at high risk12–14; 3) Regular group which consists of stable patients for whom echocardiography is undertaken on a regular schedule. Table 2 represents a customized schema of the suggested levels of expertise in echocardiography.…”