Echocardiography is the most clinically practical method of visualizing cardiac structures and directly observing changes of cardiac function during the respiratory cycle. This chapter will review heart–lung interactions and will focus on the effects of intrathoracic pressure variation on cardiac function that can be measured with advanced critical care echocardiography. These measurements are derived from observing respirophasic variation of stroke volume (SV) and help the intensivist to guide management of haemodynamic failure. The heart–lung interactions that occur with changes in intrathoracic pressure variation have utility in identification of preload sensitivity and adverse patient ventilator interaction. Measurement of the systolic velocity envelope with pulsed-wave Doppler is a requisite skill in order to identify SV variation, as is the recognition that the measurements may be difficult with transthoracic echocardiography.
This chapter covers the role of echocardiography in acute and critical care. This includes ‘front door’ echocardiography, the safeguarding of patient care, cardiopulmonary resuscitation, and acute diagnostics. The chapter then examines the circulating volume, fluid responsiveness, advanced haemodynamics, and special circumstances in the critically ill patient.
Echocardiography is being increasingly deployed as a diagnostic and monitoring tool in the critically ill. This rise in popularity has led to its recommendation as a core competence in intensive care, with several training routes available. In the peri-arrest and cardiac arrest population, point of care focused echocardiography has the potential to transform patient care and improve outcomes. Be it via diagnosis of shock aetiology and reversibility or assessing response to treatment and prognostication. This narrative review discusses current and future applications of echocardiography in this patient group and provides a structure with which one can approach such patients.
Bedside Focused Cardiac Ultrasound in COVID-19 from the Wuhan Epicenter: The Role of Cardiac Point-of-Care Ultrasound, Limited Transthoracic Echocardiography, and Critical Care Echocardiography
