Category Archives: Echocardiography

#ESICMtv webinar – Haemodynamic management in #COVID19 patients

This webinar presents how the COVID-19 crisis is impacting countries in Europe. Four experts provide an overview of the current WHO treatment guidelines and explore – using individual case reports – the patient benefits of advanced haemodynamic monitoring in the ICU.

The experts:

Co-Presenter: Prof. Jacques Duranteau is Professor and Head of Anaesthesiology and Intensive Care at Bicêtre University Hospital, Paris, and President of the Medical Committee of Paris-Saclay University Hospitals.

Co-Presenter: Antonio Messina isa Researcher andSenior Consultant in the Intensive Care Unit of the Humanitas Research Hospital, Milan.  His fields of interest include haemodynamic monitoring, heart-lung interaction and perioperative medicine.

Co-Presenter: Dr Manuel Ignacio Monge García of the Intensive Care Unit, Hospital Universitario del SAS, Jerez de la Frontera, Spain is an ICU doctor mainly dedicated to haemodynamic monitoring and cardiovascular physiology applied to bedside monitoring.

Moderator: Prof. Michael (Monty) G. Mythen is the Smiths Medical Professor of Anaesthesia & Critical Care at University College London.  He is also an Elected Council Member of the Royal College of Anaesthetists and leads their perioperative medicine programme.

The Video:

The presentations

This one on the current status in Italy, UK, Spain and France is particularly interesting….




Renske chats with Jim Watchorn and Sam Hutchings about the kidney! At #LIVES2019

 

ABSTRACT

All adult intubated patients in critical care were eligible for inclusion using an emergency waiver of consent. A minimum of four standardized video clips were taken by an investigator using an incident dark field (IDF) video-microscope (Cytocam, Braedius Medical, NL) who subsequently calculated a POEM score and recorded the time taken. On completion a second investigator blinded to the results of the first repeated this process. At a later stage (>1 month) investigators re-scored their own and their co-investigators images. Scores were analysed using Cohens weighted Kappa score to provide intra-user, inter-user and test-retest reliability. A kappa statistic was also calculated for test-retest reliability for POEM score 1-3 against POEM score 4-5 which is the threshold for fluid administration used in an ongoing interventional study (Clinical Trials.gov  ID).

Advanced Critical Care Echocardiography Course- Day 1

Introduction (De Backer)

Consensus statement on training in 2014 https://www.ncbi.nlm.nih.gov/pubmed/24615559  – this is the basis of the ESICM’s European Diploma in advanced critical care EchoCardiography (EDEC) https://www.esicm.org/education/edec-2/

CICM Levels of training https://onlinelibrary.wiley.com/doi/full/10.1002/ajum.12127

So what does advanced CCE measure compared to basic?

-Colour doppler looking at flow patterns and valvular lesions,

-spectral doppler for quantifying valvular abnormalities, measuring cardiac output and measuring intracardiac pressures

-Heart lung interactions

TEE is recommended as essential in EDEC

 

TOE Views (Vieilland- Baron)

http://www.echo-rea.uvsq.fr/echocardiographie-en-reanimation/langue-en/open-educational-resources/the-most-common-echocardiographic-views/03-transesophageal-echocardiography-the-most-common-views-248923.kjsp?RH=1354638851042

Practice online with the Toronto Virtual TEE simulator http://pie.med.utoronto.ca/tee/

LV Systolic function- Vieillard-Baron

-LV Dilation suggests a chronic injury

-LV Systolic dysfunction does not mean cardiogenic pulmonary oedema

-LV systolic function is a combination of contractility and afterload

-RWMA is ischaemia until proven otherwise

LV Systolic Function- Vignon

At the advanced level we are going way beyond “eyeballing” ejection fraction…

 

LV Systolic function- Dessap

Assess in all views:

Visual impression
LV EF (Ideally Simpson’s method of discs)
LV FAC

Don’t forget the importance of afterload!
Good images can be obtained with TTE 90% of the time.

If you are still struggling, strain is becoming more widely available…

LV Diastolic function- McLean

This is an area without much evidence in the critically ill…

ASE recommendations for LV diastolic dysfunction https://asecho.org/wp-content/uploads/2016/03/2016_LVDiastolicFunction.pdf

Applications of diastolic dysfunction guidelines in sepsis https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-017-0342-x

How to measure Diastolic function- Slama

This is really hard!

Problem with these tools is that mitral flow/pulmonary venous flow/Propagation velocity are all rather load dependent
Ea (e’) is probably least of these

EDEC Accreditation structure (De Backer)

Register here https://www.esicm.org/education/edec-2/

Pericardial disease and echo (Paul Mayo)

Twitter thread here https://twitter.com/iceman_ex/status/1177950552526864384

Whatever you do don’t forget that tamponade is a CLINICAL diagnosis!!

Many thanks to all the amazing speakers for sharing their knowledge.