title: Transthoracic focused rapid echocardiographic examination: real-time evaluation of fluid status in critically ill trauma patients.
abstract: BACKGROUND
  A transthoracic focused rapid echocardiographic evaluation (FREE) was developed to answer specific questions about treatment direction regarding the use of fluid versus ionotropes in trauma patients. Our objective was to evaluate the clinical utility of the information obtained by this diagnostic test.
  
  
  METHODS
  The FREE was performed by an ultrasonographer or an intensivist and interpreted by a surgical intensivist using a full service portable echo machine (Vivid i; GE Healthcare). The clinical team ordering the examination was surveyed before and after the test was performed.
  
  
  RESULTS
  During a 9-month study period, the FREE was performed in 53 patients admitted to our trauma critical care units. In 80% of patients, an estimated ejection fraction was obtained. Moderate and severe left ventricular dysfunction was diagnosed in 56% of patients, and right heart dysfunction was found in 25% of the patients. Inferior vena cava (IVC) diameter and IVC respiratory variation was visualized in 80% of patients. In 87% (46 of 53), the FREE was able to answer the clinical question asked by the primary team. Strikingly, in 54% of patients, the plan of care was modified as a result of the FREE examination.
  
  
  CONCLUSIONS
  IVC diameter and IVC respiratory variation was able to be obtained in the majority of cases, giving an estimate of fluid status. Estimation of ejection fraction was useful in guiding the treatment plan regarding the requirement of fluid boluses versus ionotropic support. We conclude that the FREE can provide meaningful data in difficult to image critically ill trauma patients.
authors.affiliation: Virginia Commonwealth University, West Hospital, Richmond, Virginia 23298, USA. pfanand@gmail.com
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrada
authors.forename: Sarah
authors.initials: S
authors.lastname: Murthi
authors.forename: Rahul J
authors.initials: RJ
authors.lastname: Anand
authors.forename: Grant V
authors.initials: GV
authors.lastname: Bochicchio
authors.forename: Thomas
authors.initials: T
authors.lastname: Scalea
mesh_terms: D001810:Blood Volume / Q000502:physiology; D003422:Critical Care / Q000379:methods; D004452:Echocardiography / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging; D014882:Water-Electrolyte Balance / Q000502:physiology*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*