Ten good reasons why everybody can and should perform cardiac ultrasound in the ICU

Abstract

Critical care ultrasonography (CCUS) has been defined as an ultrasound evaluation of the heart, abdomen, pleura and lungs at the bedside by the intensivist, 24/7. Within CCUS, critical care echocardiography (CCE) is used to assess cardiac function and more generally haemodynamics. Experts in haemodynamics have published a 'consensus of 16' regarding an update on haemodynamic monitoring. They reported the ten key properties of an 'ideal' haemodynamic monitoring system, which perfectly match the ten good reasons we describe here for performing CCE in critically ill patients. Even though unfortunately no evidence-based medicine study is available to support this review, especially regarding CCE-related improvement of outcome, many clinical studies have demonstrated that CCE provides measurements of relevant, accurate, reproducible and interpretable variables, is easy to use, readily available, has a rapid response time, causes no harm, and is cost-effective. Whether it is operator-independent is obviously more debatable and is discussed in this review. All these characteristics are arguments for the extensive use of CCE by intensivists. This is why experts in the field have recommended that a basic level of CCE should be included in the training of all intensivists.

The utilization of critical care ultrasound to assess hemodynamics and lung pathology on ICU admission and the potential for predicting outcome

“…This study has demonstrated that it is feasible to complete the CCUS exam on ICU admission with in a short period (less than 30 minutes) to add more valuable information about the patient besides clinical characteristics, lab work, and other imaging exams. In the consideration of properties of noninvasive, responsible, rapid, affordable and reproducible data collecting at the bedside and providing specific data that may not be obtained from other diagnostic methods[ 33 ], we believe it is precious to encourage the CCUS exam to be utilized on admission in intensive care unit.…”

The PIEPEAR Workflow: A Critical Care Ultrasound Based 7-Step Approach as a Standard Procedure to Manage Patients with Acute Cardiorespiratory Compromise, with Two Example Cases Presented

“…Critical care ultrasound has been widely used as a reliable tool in a whole setting of critical care practice [ 1 – 3 , 48 , 75 ]. As noninvasive, visible point of care handling both monitoring and diagnosis, it has the advantages that any other single tool can not have [ 48 ]. In an intensivist's hand, critical care ultrasound can not only visualize the organ structure as well as the physiopathological changes but also find out the clues to instruct the diagnosis and source searching.…”

“…Echocardiography is supposed to be the first part and is done as two steps, and the first step is the fast and global assessment of the heart (heart glance) and thus identifies cases that need immediate life-saving intervention by intensivists or cardiologist (listed in Table 1 ). It is crucial that such situations be identified as early as possible to facilitate an immediate treatment, where showing the unique advantage of the critical care ultrasound compared to the other tools we have in the ICU [ 48 ]. The second step is assessing the circulatory system in the following order: (1) assessing the IVC, which aims to identify the volume status and fluid responsiveness [ 49 ]; (2) evaluating the right heart to identify the acute right heart dysfunction that may harm the output of left side of the heart or cause a false positive monitoring which may mislead the treatment [ 50 – 54 ]; (3) assessing the function of diastole and systole of left heart; (4) deducing systemic vascular resistance.…”

The debate on fluid management and haemodynamic monitoring continues: between Scylla and Charybdis, or faith and evidence…

“…Cardiac ultrasound is more often being used and can indeed be considered as the gold standard and the 'modern stethoscope' for the intensivist. Antoine VieillardBaron and Daniel Lichtenstein, experts in their field, give us their ten best reasons to perform cardiac [51] and lung [52] ultrasound in this issue of AIT.…”