A Acute aortic regurgitation (AR), 124 128 Acute aortic syndrome (AAS) classic aortic dissection diagnosis, 251 263 evolutive patterns, 253 255 pathology, 250 251 classifications, 247 248 incomplete aortic dissection diagnosis, 265, 269 evolutive patterns, 267 pathology, 263 265 intramural aortic hematoma diagnosis, 256 257, 264, 265 evolutive patterns, 257 258 pathology, 255 256, 263 management strategy, 267 268 patient, risk identification, 248 253 penetrating aortic ulcer diagnosis, 260 262 evolutive patterns, 262 263 pathology, 258 260 Acute circulatory failure (ACF) acute therapy, efficacy and safety, 106 cardiogenic shock, 117-129, 144 145 Complicating cardiac surgery, 239 244 Differential diagnosis, 100 105 echocardiography, steps, 101 102 mechanisms, 101 Monitoring effects of therapy, 106 pulmonary venous congestion, 103 104 Septic shock, 109-115 systemic venous congestion, 104 105 Tamponade, 152-160 Acute cor pulmonale (ACP) clinical scenarios acute respiratory distress syndrome (ARDS), 145 acute RV failure, of sepsis, 145 massive pulmonary embolism, 144 145 preload/volume responsiveness, 146 RV infarction, 145 definition, 135 and pulmonary hypertension, 140 RV diastolic overload, 138 139 RV systolic overload, 135 137 vs. subacute chronic cor pulmonale, 139 140 Acute myocardial infarction, cardiogenic shock cause, 118 diagnosis, 118 mechanical complications acute MR, 121 123 ventricular free-wall rupture, 121 ventricular septal rupture, 119 121 pulmonary artery systolic pressure, 119 Acute respiratory distress syndrome (ARDS), 145, 187 189. See also Pulmonary edema echocardiography use, 195 197 PEEP effect, monitor, 199 200 prone positioning role, 200, 201 tidal volume and PP adaptation, 198 199 Acute right ventricular failure, 237 238 Alveolar pressure, 43 Aortic blood flow, 85 Aortic dissection, 126, 237 240 Aortic stenosis (AS), 126 127, 129 Arrhythmias atrial fibrillation (AF), hemodynamic consequences cardiac output effects, 90 91 diastolic function effects, 90 systolic function effects, 90 echocardiographic evaluation, of patients Doppler assessment, 94 LV diastolic pressure, 92 93 LV strain and strain rate, 94 stroke volume, 91 92 systolic function, 91 Atrial fibrillation (AF), hemodynamic consequences cardiac output effects, 90 91 diastolic function effects, 90 systolic function effects, 90 B Blunt cardiac trauma cardiac rupture, 227 228 mechanisms of injury, 226 segmental/global ventricular systolic function, 227 septal defects, 228 229 valvular injuries, 228 229 Blunt chest trauma management, 222 226 traumatic aortic injury angiography, 209 210 D. De Backer et al. (eds.), Hemodynamic Monitoring Using Echocardiography in the Critically Ill, DOI: 10.1007/978-3-540-87956-5, Springer-Verlag Berlin Heidelberg 2011 307
308 chest radiography, 208 209 clinical presentation, 207 208 computed tomography, 210 212 incidence and natural history, 205 206 mechanism of injury, 206 pathology, 206 207 TAI screening, 221 222 transesophageal echocardiography (TEE), 212 221 C Cardiac depression, septic shock Cardiac function alteration aortic blood flow, 85 contractility, 83 84 LV external mechanical power, 85 86 LV wall stress relationship, 85 maximal elastance, 86 87 mitral regurgitation jet acceleration time, 85 speckle tracking, 87 velocity of circumferential fiber (VCF) shortening, 84 85 Cardiac tamponade echocardiographic identification clinical context, 158 Doppler analysis, 157 158 two-dimensional, 157 Cardiogenic shock acute myocardial infarction cause, 118 diagnosis, 118 mechanical complications, 119 123 pulmonary artery systolic pressure, 119 diagnosis, 117 118 myocarditis, 124 stress cardiomyopathy, 123 124 valvular disease acute aortic regurgitation (AR), 124 128 aortic stenosis (AS), 126 127, 129 mitral stenosis (MS), 128 130 Cardiopulmonary bypass (CBP) postoperative period localized tamponade, 243 mechanical valve thrombosis, 244 transesophageal echo, 244 transthoracic echo, 244 prior to acute right ventricular failure, 237 238 aortic dissection, 237 240 hypovolemia, 235 237 intraoperative TEE, recommendations, 235, 236 weaning from dynamic left ventricular outflow tract obstruction, 241 242 injuries, surgical procedure, 242 243 ischemic disorders, 240 241 Circulatory failure acute therapy, efficacy and safety, 106 definitions, 100 diagnostic algorithms acute circulatory failure, 101 102 conditions, 101 LV systolic function, 102 103 pulmonary venous congestion, 103 104 RV systolic function, 103 systemic venous congestion, 104 105 echocardiography advantages, 100 indications, 100 Classic aortic dissection diagnosis, 251 263 evolutive patterns, 253 255 pathology, 250 251 Critical care echocardiography (CCE) competence level advanced, 277 278 basic, 276 277 curriculum advanced, 278 280 basic, 278 definition, 275 276 history, 1 2 indications, 3 4 specificities, 2 heart lung interactions, 3 hemodynamic assessment, 3 nonscheduled management and care, 3 TEE, tolerance of, 4 5 therapeutic impact, 5 6 TTE vs. TEE, 4 D Destination therapy. See Extracorporeal life support, ICU Doppler echocardiography, principles of color doppler, 20, 22 continuous-wave (CW) doppler, 17, 21, 22 pulsed-wave (PW) doppler, 19, 22 E Ejection fraction evaluation LV volume estimation, 81 short-axis area measurements, LV, 81 unidimensional approach, M-mode, 80 81 measurement, 81 83 RV systolic dysfunction assessment, 142 Extracorporeal life support, ICU monitoring assistance, echo and circulatory failure, 167 170 contraindications, 166 IABP, 166 Impella, 166, 167 principles, 165 respiratory failure, 171 172 short-term circulatory assistance axial pumps, 164 catecholamine-resistant cardiac failure, 163 centrifugal pumps, 164 165 intra-aortic balloon pump (IABP), 164 weaning from assistance, 172 174
309 F Fluid challenge cutoffs, 71 72 guidance, echocardiography, 75 hydrostatic pressure changes, 72 indications response evaluation, 56-57, 74 76 tolerance evaluation, 73 74 type and administration rate, 73 Fluid requirements assessment fluid challenge cutoffs, 71 72 hydrostatic pressure changes, 72 indications, 72 76 fluid responsiveness clinical application, 67 definition, 61 62 dynamic parameters, 64 67 Frank Starling relationship, 62 hypovolemia, 61 static parameter, 62 63 Fractional area contraction LV, 80-81 RV, 142 Frank Starling curve, 62 H Heart lung interactions, in mechanical ventilation intravascular vs. transmural pressures, 44 pressures types, 43 44 reverse pulsus paradoxus ddown component, 45 47 definition, 45 dup component, 47 49 Hemodynamic assessment alternative hemodynamic measurements cardiac output, 285 flow and global tissue perfusion, 285 PAC monitoring, 286 pulmonary artery pressure, 285 stroke volume variation, 285 echocardiography merits cardiac function, 106, 284 transesophageal echocardiography (TEE), 278, 285 transthoracic echocardiography, 284 Hemodynamic instability. See acute circulatory failure Hydrostatic pulmonary edema, 188 191 Hypovolemia, 61 cardiopulmonary bypass (CBP), 235 237 septic shock, 109 110 I ICU applications, echocardiographic technologies hand-carried ultrasound (HCU), 301, 303 intracardiac echocardiography (ICE), 299 301 Impella system, 164 Incomplete aortic dissection diagnosis, 265, 269 evolutive patterns, 267 pathology, 263 265 Inotropes/vasodilators, 57, 59 Intra-aortic balloon pump (IABP), 164, 166 Intracardiac echocardiography (ICE), 299 301 Intramural aortic hematoma (IAH) diagnosis, 256 257, 264, 265 evolutive patterns, 257 258 pathology, 255 256, 263 Intrathoracic pressure, 43 44 Intravascular pressure, 44 Ischemic disorders, CBP, 240 241 K Knobology, TTE artifact, 15 16 image resolution, 14 15 ultrasound, 14 L Left ventricular (LV) diastolic pressure volume, 181 evaluation, 92 93 Left ventricular strain (LVSt), 94 Left ventricular (LV) systolic function evaluation cardiac function alteration aortic blood flow, 85 contractility, 83 84 LV external mechanical power, 85 86 LV wall stress relationship, 85 maximal elastance, 86 87 mitral regurgitation jet acceleration time, 85 speckle tracking, 87 velocity of circumferential fiber (VCF) shortening, 84 85 ejection fraction evaluation, 80 81 measurement, 81 83 systolic function evaluation, 79 81 Left ventricular wall area index (LVWAI), 172 Localized tamponade, 243 LV filling pressures estimation Doppler assessment validation, 182 183, 185, 188 Doppler patterns evolution, 181 182, 185, 186 principles and technique, 180, 182, 183 M Massive pulmonary embolism, 144 145 Maximal elastance, 86 87 Mechanical valve thrombosis, 244 Mechanical ventilation, 195 Mitral inflow, 74 Mitral regurgitation jet acceleration time, 85 Mitral stenosis (MS), 128 130 M-mode echocardiography, 16 17 Myocardial depression, septic shock Myocardial performance index (MPI), 144 Myocarditis, 124 N Nitric oxide inhalation, 57 58
310 P Passive leg-raising (PLR) test, 66 67 Penetrating aortic ulcer diagnosis, 260 262 evolutive patterns, 262 263 pathology, 258 260 Pericardial effusion. See also Cardiac tamponade; Pericardiocentesis anatomy, 151 identification, 152 156 Pericardiocentesis equipment requirements, 158 159 identification, 158 site selection, 159 160 Pericardium anatomy, 151 Pulmonary artery occluded pressure (PAOP), 74 Pulmonary artery pressures. See Right ventricular function Pulmonary edema definitions, 177 179 diagnostic algorithm acute respiratory distress syndrome vs. hydrostatic pulmonary edema, 187 189 hydrostatic pulmonary edema, 188 191 ongoing therapy influence, 191 192 LV diastolic function and filling pressures, 179 LV filling pressures estimation Doppler assessment validation, 182 183, 185, 188 Doppler patterns evolution, 181 182, 185, 186 principles and technique, 180, 182, 183 pathophysiology left ventricular (LV) diastolic pressure volume, 181 systolic and diastolic left ventricular failure, 178 181 R Real-time 3D echocardiography (RT3DE) applications, 296 301 full-volume data, 295 limitations, 296 prototype software, 297 texture tracking, 297, 298 three-dimensional volumetric rendering, 299 Real-time 3D TEE (RT3D TEE), 299, 302 Reverse pulsus paradoxus ddown component, 45, 47 hemodynamic effect, mechanical ventilation, 47 RV afterload, 46 47 systemic venous return, 45 46 definition, 45 dup component, 47 49 Right ventricular function acute cor pulmonale (ACP) cor pulmonale and pulmonary hypertension, 140 definition, 135 RV diastolic overload, 138 139 RV systolic overload, 135 137 vs. subacute chronic cor pulmonale, 139 140 anatomy and function contraction manners, 133 134 pathophysiological changes, 134 135 PHT and right-heart dysfunction evaluation, 134 pressure/volume loop technique, 134 clinical scenarios acute respiratory distress syndrome (ARDS), 145 acute RV failure, of sepsis, 145 massive pulmonary embolism, 144 145 preload/volume responsiveness, 146 RV infarction, 145 echocardiographic estimates, pulmonary artery pressure, 140 141 systolic dysfunction assessment contractile function, 141 dp/dt, 143 144 ejection fraction, 142 fractional area contraction, 142 myocardial performance index (MPI), 144 tissue doppler, 143 tricuspid annular motion, 142 143 S Septic shock bacteremia/fungemia, 115 echocardiographic evaluation cardiac function, 114 115 cardiac output, 112 clinical management, 111, 112 response to fluids, 113 114 hypovolemia, 109 110 myocardial depression, 115 Speckle tracking, 87 applications, 292 295 limitations, 292 strain calculation, 292 systolic contraction, 292 Stress cardiomyopathy, 123 124 Stroke volume and cardiac output measurement echocardiography and doppler limitations, 55 mitral/pulmonary valves, 55 step-by-step procedure, 53 55 heart rate, 53 systemic arterial pressure, 52 therapeutic maneuver effects fluids, 56 57 inotropes/vasodilators, 57, 59 nitric oxide inhalation, 57 58 tissue perfusion, 51 venous return determinants, 52 53 Systolic and diastolic left ventricular failure, 178, 180 T Tamponade echocardiographic identification clinical context, 158 Doppler analysis, 157 158 two-dimensional, 157
311 TEE. See Transesophageal echocardiography Thoracic trauma blunt cardiac trauma cardiac rupture, 227 228 mechanisms of injury, 226 segmental/global ventricular systolic function, 227 septal defects, 228 229 valvular injuries, 228 229 blunt chest trauma management, 222 226 traumatic aortic injury, 205 222 Tissue Doppler imaging (TDI), 143 constrictive vs. restrictive cardiomyopathy, 290 dobutamine stress echocardiography, 291 for the evaluation of PAOP 181-189 hypertrophic, nonobstructive cardiomyopathy (HNOCM), 292 left ventricular ejection fraction (LVEF), 291 pulsed wave Doppler, 289 RV function, 141, 143 velocity and strain limitations, 290 in weaning from assist cardiac devices, 173 Transesophageal echocardiography (TEE) acute respiratory distress syndrome (ARDS), 196 advantages, 32 blunt chest trauma, 212 221 equipment, 31 32 hemodynamic assessment, in ICU, 37 38 hemodynamic instability, 235 safety considerations, 32 two-dimensional imaging aortic views, 36 37 deep transgastric views, 33, 34 mid-esophageal views, 34 35 transgastric short-axis views, 32 33 upper esophageal views, 35 36 Transmural pressure, 44 Transpulmonary pressure (TPP), 44 Transthoracic echocardiography (TTE) apical four-and five-chamber views, 23 24 apical two-and three-chamber views, 26 hemodynamic assessment, 28 knobology artifact, 15 16 image resolution, 14 15 ultrasound, 14 limitations of, 28 29 parasternal long-axis view, 21 23 parasternal short-axis view, 23 25 subcostal view, 24 25, 27 suprasternal view, 25 26, 28 ultrasound modalities applications, in intensive care unit, 18 doppler echocardiography, 17 22 M-mode echocardiography, 16 17 two-dimensional echocardiography, 17 uses, 26 28 Tricuspid annular motion, 142 143 Two-dimensional echocardiography, 17 Two-dimensional imaging, TEE aortic views, 36 37 deep transgastric views, 33, 34 mid-esophageal views, 34 35 transgastric short-axis views, 32 33 upper esophageal views, 35 36 U Ultrasound, principles, 14 V Valvular disease, cardiogenic shock acute aortic regurgitation (AR), 124 128 aortic stenosis (AS), 126 127, 129 mitral stenosis (MS), 128 130