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.