Focused comprehensive, quantitative, functionally based echocardiographic evaluation in the critical care unit is feasible and impacts care.
OBJECTIVE
To determine whether comprehensive quantitative echocardiogram could be used as a resuscitation tool in critically ill surgical patients and to assess its effect on patient care.


METHODS
Prospective observational.


METHODS
The Trauma and Surgical Intensive Care Units of the University of Maryland Medical Center.


METHODS
Critically ill trauma and surgical patients.


METHODS
The Focused Rapid Echocardiographic Evaluation (FREE), an abbreviated version of a comprehensive transthoracic echocardiogram, which is under an approved protocol, was performed.


RESULTS
Over a 30-month period, 791 FREEs were performed on 659 patients. The mean patient age was 60 (±17) years. Ninety-one percent were intubated and 80% were postoperative. Ejection fraction was reported for 95%, and cardiac index was reported for 89% of FREE studies. Right heart function was assessed for 94%. Measures of volume status--internal left ventricular diameter, inferior vena cava diameter, diameter change, and stroke volume variation--were reported for 88%, 79%, 75%, and 89% of patients, respectively. The FREE was judged to be useful by the consulting primary care team for 95% of patients, and altered the plan of care for 57%. The most common change was administration of a fluid bolus (43%), followed by change from an original prestudy plan to one of monitoring (24%), diuresis (23%), addition/titration of an inotropic agent (19%), and/or addition/titration of a vasoconstrictor (8%).


CONCLUSIONS
The FREE is feasible and alters care in the intensive care unit by providing clinical data not otherwise available at the bedside. Further studies are warranted to assess the impact of comprehensive echocardiogram-directed resuscitation on patient outcomes.
Department of Surgery, Division of Trauma and Surgical Critical Care, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201.
Sarah B
SB
Murthi
Department of Surgery, Division of Trauma and Surgical Critical Care, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201.
Manjunath
M
Markandaya
U.S. Air Force Center for Sustainment of Trauma and Readiness Skills, 22 S. Greene Street, Baltimore, MD 21201.
Raymond
R
Fang
Department of Anesthesiology, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201.
Caron M
CM
Hong
Department of Anesthesiology, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201.
Samuel M
SM
Galvagno
Department of Surgery, Division of Trauma and Surgical Critical Care, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201.
Mattew
M
Lissuaer
Department of Surgery, Division of Trauma and Surgical Critical Care, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201.
Lynn G
LG
Stansbury
Department of Surgery, Division of Trauma and Surgical Critical Care, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201.
Thomas M
TM
Scalea
D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D016276:Ventricular Function / Q000502:physiology*