Echocardiography for Intensivists

421 Pages·2012·17.972 MB·English

by  Dionisio F. Colella, Paolo Prati, Armando Sarti (auth.), Armando Sarti, F. Luca Lorini (eds.)

Echocardiography for Intensivists
Armando Sarti F. Luca Lorini
•
Editors
Echocardiography
for Intensivists
Forewords by A. Raffaele De Gaudio
and Alfredo Zuppiroli
123
Editors
Armando Sarti F. LucaLorini
Department of Anesthesiaand Department of Anesthesiaand
Intensive Care Intensive Care
SantaMaria NuovaHospital Ospedali RiunitidiBergamo
Florence Bergamo
Italy Italy
ISBN 978-88-470-2582-0 ISBN 978-88-470-2583-7 (eBook)
DOI 10.1007/978-88-470-2583-7
SpringerMilanHeidelbergNewYorkDordrechtLondon
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(cid:2)Springer-VerlagItalia2012
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Foreword by A. Raffaele De Gaudio
Since its beginning in the early 1950s by Edler and Hertz, echocardi-
ography has developed from simple amplitude and brightness modes,
through motionmode,tothepresentdayreal-time2Dand3Dimaging
modalities. Its role has extended beyond cardiology into the operating
rooms as a perioperative monitor and into critical care and emergency
medicine. Far from being competitive or conflicting, the use of this
technique by intensivists and cardiologists is complementary. In criti-
cally ill patients, echocardiography provides useful and reliable infor-
mation,inanoninvasiveandtimelymanner.Thistechniquehasbecome
a valuable tool for diagnosing and treating a myriad of conditions
commonlyencounteredinthesepatients.Thehemodynamicassessment
within few minutes appears to be the best approach in shock states. In
addition, the evolution of technologies produced a quality of imaging
that allows us to obtain clear hemodynamic data in mechanical venti-
latedpatients.Clinicalstudiesshowedasignificantroleinvariousacute
clinical situations, such us acute respiratory failure and severe chest
trauma. Moreover, the use of ultrasonography for detection of pleural
effusion,thoracocentesis,andcentrallineplacementisnowaninevitable
choice. It has long been known that ultrasonography leads to relevant
changes in therapy. However, despite its easy use, the diffusion of
ultrasonographyamongcriticalcarephysicianshasbeenlimitedandthe
technique is not yet available in most intensive care units. A European
survey demonstrated that only 20 % of intensivists have been certified.
All physicians in charge of critically ill patients should be trained in
ultrasonography, and in particular in echocardiography. There is an
urgent need to reach this objective organizing training programs and
editing new books regarding this specific topic.
Following all these reasons, it is a great pleasure to introduce this
textbook that summarizes the state of the art and the standard of care
for the use of echocardiography and ultrasonography in the perioper-
ative and intensive care setting. This book is intended to highlight
established principles, evolving standards of care and new opportuni-
tiestoprovideexcellenceinpatientcare.TheeditorDr.ArmandoSarti,
with the contribution mainly of Italian leaders, produced a work that
is a practical, handy reference for students, residents, and specialists.
v
vi ForewordbyA.RaffaeleDeGaudio
This new accomplishment follows the first and already appreciated
Italian edition. With this English version we now have an Italian con-
tribution to provide a teaching program for colleagues who need a
certification on ultrasonography.
A. Raffaele De Gaudio M.D.
Professor of Anesthesiology and Intensive Care
School of Medicine, University of Florence
Foreword by Alfredo Zuppiroli
The promises of the title are fully maintained, as the book is a perfect
demonstration of the meaning of the term ‘‘for’’. This is not a sterile,
academiclistoftopics;onthecontrary,everypageisdeeplyrootedinthe
dailyclinicalpractice;everyitemisaddressedstartingfromanenormous
personal experience; every message shows the huge theoretical and
practical background of the authors. This is not a book ‘‘of’’ Echocar-
diography, but isreally a book ‘‘for’’clinical bedside decision making.
As any other diagnostic tool, echocardiography has a great potential
onlyifcorrectqueriesaremade.Otherwise,inappropriateanswersmaybe
found.Everypatient,particularlythecriticalones,deservethatfindingsare
interpreted in order to guide management in a safe and effective way.
Therefore the book can or, better, must be read—and re-read a lot of
times!—notonlybyintensivists,butbyanyonewhomayfacewithunstable
patients. I am dreaming of a health care organization where ‘‘political’’
decisionsaremadenotfromthephysicians’ornurses’pointofview,but
aresetonpatients’needs.Criticallyillpatientsarenotonlyhospitalizedin
ICUs;criticalphasesofadiseasecanoccureverywhereandateverytime,
eveninlowcaresettings.Asaconsequence,alsoduetotheavailabilityof
miniaturizedsystems,theauthorsareprovidingvirtuallyeverydoctorwith
apowerfultoolforimprovingtheirdiagnosticcapabilities.
Today, half a century after its invention and years of use limited to
cardiologistsandcardiologicalsettings,echocardiographyisnowmature
enough to have widespread use when and where it is necessary. I am
clearlyremindedofmyfirstexperiences,inthe1980s,inheartsurgeryof
ICUpatients.Howhardweremyeffortstoconvinceanesthesiologiststo
usebeta-blockers,stopinotropes,andgivefluidswhenechocardiography
allowed us to recognize hypovolemia as the cause of a low output
condition!
Diagnosis,thatis‘‘knowledgebymeansof’’anytool,isnotaplatonic
idea; it is a goal that must be pursued with humility and strictness. The
authors are pointing toward the right way, providing us with a sharp,
enduring light.
Florence, September 2012 Alfredo Zuppiroli
Department of Cardiology
Santa Maria Nuova Hospital, Florence
vii
Contents
Part I Ultrasound and Use of the Echo Machine
1 Essential Physics of Ultrasound and Use of the
Ultrasound Machine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Dionisio F. Colella, Paolo Prati, and Armando Sarti
Part II Standard Echocardiographic Examination
2 Ultrasound Morphology of the Heart:
Transthoracic Examination. . . . . . . . . . . . . . . . . . . . . . . . 21
Armando Sarti, Simone Cipani, and Costanza Innocenti
3 Transthoracic Echocardiography in the ICU: The Patient
Who Is Difficult To Study. . . . . . . . . . . . . . . . . . . . . . . . . 41
Piercarlo Ballo
4 Ultrasound Morphology of the Heart:
Transesophageal Examination. . . . . . . . . . . . . . . . . . . . . . 51
F. Luca Lorini, Carlo Sorbara, and Sergio Cattaneo
5 Three-Dimensional Echocardiography. . . . . . . . . . . . . . . . 61
Mauro Pepi and Gloria Tamborini
Part III Essential Functional Echo-Anatomy
6 The Left Ventricle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Armando Sarti, Claudio Poli, and Silvia Marchiani
7 The Right Ventricle and Pulmonary Artery. . . . . . . . . . . . 91
Luigi Tritapepe, Vincenzo De Santis, and Massimo Pacilli
8 Left and Right Atria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Luigi Tritapepe, Francesca Pompei, and Claudio Di Giovanni
9 Pericardium and Pericardial Diseases. . . . . . . . . . . . . . . . 105
F. Luca Lorini, Stefania Cerutti, and Giovanni Didedda
ix
x Contents
10 The Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Luigi Tritapepe, Domenico Vitale, and Roberto Arzilla
11 Inferior and Superior Venae Cavae. . . . . . . . . . . . . . . . . . 121
Massimo Milli
12 Ischemia and Myocardial Infarction . . . . . . . . . . . . . . . . . 125
F. Luca Lorini, Marialuigia Dello Russo, and Elena Pagani
13 The Cardiomyopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
F. Luca Lorini, Alessandra Rizza, and Francesco Ferri
14 Cor Pulmonale and Pulmonary Hypertension . . . . . . . . . . 143
Lorenzo Grazioli, F. Luca Lorini, and Angelo Vavassori
15 Mitral Valve. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Ilaria Nicoletti, Carla Avallato, and Alessandro Locatelli
16 The Aortic Valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Irene Betti
17 Tricuspid and Pulmonary Valves . . . . . . . . . . . . . . . . . . . 171
Claudio Poli, Armando Sarti, and Vanni Orzalesi
18 Endocarditis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Roger L. Click
19 Prosthetic Valve Evaluation . . . . . . . . . . . . . . . . . . . . . . . 183
Roger L. Click
20 Cardiac Tumors and Masses. . . . . . . . . . . . . . . . . . . . . . . 189
Roger L. Click
21 Congenital Septal Abnormalities in the Adult Patient . . . . 197
F. Luca Lorini, Cristian O. Mirabile, and Moreno Favarato
22 Essential Pediatric Echocardiography . . . . . . . . . . . . . . . . 207
F. Luca Lorini, Simona Marcora, and Mariavittoria Lagrotta
Part IV Echocardiography in the ICU and OR:
Basic and Advanced Applications
23 Echocardiographic History, Echocardiographic Monitoring,
and Goal-Directed, Focus-Oriented,
and Comprehensive Examination . . . . . . . . . . . . . . . . . . . 221
Armando Sarti, Simone Cipani, and Massimo Barattini
24 Intraoperative Echocardiography in Cardiac Surgery . . . . 229
Carlo Sorbara, Alessandro Forti, and F. Luca Lorini
Contents xi
25 General Hemodynamic Assessment. . . . . . . . . . . . . . . . . . 235
Carla Avallato, Ilaria Nicoletti, and Alessandro Locatelli
26 Contrast Echocardiography in the ICU and OR . . . . . . . . 245
Paolo Voci, Luigi Tritapepe, Demetrio Tallarico,
and Luciano Agati
27 Echo-Guided Therapy for Myocardial Ischemia . . . . . . . . 249
Michele Oppizzi, Marco Ancona, and Rachele Contri
28 Hypovolemia and Fluid Responsiveness. . . . . . . . . . . . . . . 257
Armando Sarti, Simone Cipani, and Massimo Barattini
29 ARDS, ALI, Mechanical Ventilation, and Weaning . . . . . . 267
Federica Marini, Carla Farnesi, and Armando Sarti
30 Hypotension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Luigi Tritapepe, Cecilia Nencini, and Demetrio Tallarico
31 Suspicion of Pulmonary Embolism . . . . . . . . . . . . . . . . . . 283
Alessandro Locatelli, Carla Avallato, and Ilaria Nicoletti
32 Suspicion of Acute Aortic Diseases . . . . . . . . . . . . . . . . . . 289
Luigi Tritapepe, Francesca Pacini, and Maurizio Caruso
33 Chest Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Michele Oppizzi and Rachele Contri
34 Acute Dyspnea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Gino Soldati
35 Unexplained Hypoxemia . . . . . . . . . . . . . . . . . . . . . . . . . 321
F. Luca Lorini, Bruno Rossetto, and Francesco Ferri
36 Sepsis and Septic Shock . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Armando Sarti, Simone Cipani, and Germana Tuccinardi
37 Chest Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Fabio Sangalli, Lucia Galbiati, and Roberto Fumagalli
38 Acute Atrial Fibrillation and Other Arrhythmias . . . . . . . 345
Vanni Orzalesi, Silvia Marchiani, and Armando Sarti
39 Multiorgan Donor and Transplant Patients. . . . . . . . . . . . 349
F. Luca Lorini and Lorenzo F. Mantovani
40 New-Onset Cardiac Murmur in the Unstable Patient. . . . . 355
Michele Oppizzi and Marco Ancona