Echocardiography as a Part of Haemodynamic Monitoring in Intensive Care

Overview

Introduction:
The routine application of transthoracal (TTE) and transesophageal echocardiography (TEE) extends diagnostic and consequentlytherapeutic opportunities of haemodynamic disorders. Pulmonary artery catheter (PAC) enables objective measurement and continuous monitoringof the selected parameters according to the type of the catheter. There is obvious contrib ution of TTE/TEE not only for the changes in therapy in 40%of patients without PAC but even in 40–50% of patients with already inserted PAC regardless to the main diagnosis. Methods: The authors attempted to define the haemodynamic diagnosis where PAC is indicated even after the repeated TTE/TEE investigation andwhere echocardiography alone is probably insufficient monitoring device. Haemodynamically unstable patients were enrolled to the study after thestandard monitoring methods were exhausted. Patients were investigated by TTE and TEE was applied in case that TTE provided insufficient data.The number of investigations per one case was 2–10. PAC was indicated in case of persisting haemodynamic instability or signs of low cardiac outputsyndrome. The main haemodynamic diagnosis of the patients indicated to PAC insertion was recorded as well as mortality in the groups of PAC andof TTE/TEE and APACHE II on the day of the first echocardiographic investigation and on the day of PAC insertion. Results: 163 patients were included in the study and monitored initially by TTE. 33 of them (20.2%) were investigated by TEE. 134 were monitoredonly by echocardiography with mortality 33.6%, average APACHE II was 21.0 ± 12. 29 patients (17.8%) were consecutively indicated to PAC withhigher overall mortality 48.3%, average APACHE II was insignificantly higher on insertion: 22.8 ± 8 (p > 0.05).The incidence of PAC among alladmitted (ventilated) patients was 6.8%. PAC was inserted in 10 patients with significant left ventricular (LV) systolic dysfunction with EFLV

Key words:
echocardiography - pulmonary artery catheter - haemodynamics