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)
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:
LV EF (Ideally Simpson’s method of discs)
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.