Authors (including presenting author) :
Au SY(1), Fong KM(1), Ng WYG(1)
Affiliation :
(1) Intensive Care Unit, Queen Elizabeth Hospital
Introduction :
Due to the limited availability of advanced ultrasound machines and well-trained echo-cardiographers, focused echocardiography, using simple hand-held machines and departmental specific protocols, serves as an extension of physical examination. Such focused echo protocols have been shown to help direct patient management, and are now widely adopted in emergency medicine, anesthesiology and Intensive Care Units (ICU). The clinical conditions and haemodynamics of ICU patients however change significantly during their stay. A detailed echocardiography with quantification and hemodynamic measurement, which takes an average of 15 minutes for trained practitioners, provides important information which could otherwise be missed by current worldwide-adopted focused echocardiography protocols. And importantly, echocardiographic machines capable for detailed assessment are increasingly available in ICUs under HA.
Objectives :
To study the added values of detailed over focused echocardiography in ICU
Methodology :
It is a retrospective study to evaluate the additional benefit of detailed echocardiography on top of focused ones over a 3-month period in ICU of Queen Elizabeth Hospital. Detection of new lesions of at least moderate severity, alternation of treatment direction or hemodynamic management were considered added values of detailed echocardiographic studies over focused ones. Focused echocardiography is defined by the FICE UK protocol, which includes assessment of biventricular function and size, presence of pleural or pericardial effusion or evidence of hypovolemia. Echocardiographic findings detected but for detailed echocardiography were recorded and their prevalence was presented.
Result & Outcome :
From August to October 2018, 80 out of 356 (22.5%) patients admitted had a detailed echocardiography performed. 79/80 (98.8%) had transthoracic echocardiography. 68 (86.1%) had new cardiac lesions of at least moderate severity revealed, which would have been missed by focused echocardiography. Four patients with diastolic dysfunction were detected. All these patients required follow-up management by cardiologists after ICU discharge. 52 ( 65.8% ) had their management direction altered after detailed echocardiography assessment on top of the focused ones, including initiating 3 cardiothoracic consultation for open heart operation, 5 medical treatment for acute coronary treatment, 3 coronary angiography and one confirmation of infective endocarditis. In addition, we performed 12 trans-esophageal echocardiography, 4 agitated saline and 2 microbubble tests, and 2 strain imaging to improve diagnostic yield in specific conditions. Detailed echocardiography has added benefits over focused one, especially for the continuity of care of critically-ill patients with complex cardiac physiology. Enhanced echocardiography training in ICU is warranted.
Co-location with:
