The role of echocardiography in hemodynamic monitoring.

PURPOSE OF REVIEW: Echocardiography has become more widely available to noncardiologists because of the technological advances in smaller, multipurpose ultrasound units with basic cardiac capabilities. In this review, we discuss the type of clinical information a trained intensivist can hope to obtain from bedside echocardiography and suggest the ways in which this complements traditional hemodynamic monitoring.

RECENT FINDINGS: Following a 10-h hands-on course, intensivists are able to perform and interpret a goal-oriented echocardiogram in approximately 10 min with good accuracy. Bedside echocardiography can aid in determining fluid status and qualitative cardiac ejection fraction, which can then be used immediately to guide therapy.

SUMMARY: Intensivists can safely and accurately perform goal-oriented echocardiography. Although not yet proven to influence clinical outcome, we suggest that the major utility of echocardiography is for those with distributive or mixed shock in whom target central venous pressure has been achieved without evidence of adequate tissue perfusion. In this subset of patients, echocardiography can aid in selecting those most likely to benefit from further fluid or inotropic support.