2066744 Bridging the Gap: Hemodynamic Versus Anatomic Transthoracic Echocardiography in the Critically Ill

Abstract

ObjectivesFocused cardiac ultrasound (FCU) is commonly used to evaluate cardiac function in critically ill patients, but leaves important questions unanswered. We developed and made clinically available the Focused Rapid Echocardiographic Evaluation (FREE); a hybrid between an FCU and the quantitative anatomic assessment of standard transthoracic echocardiogram (TTE). We sought to compare the data provided by the FREE and TTE, and determine the impact of the FREE on the plan of care.MethodsThe FREE exam evaluates cardiac function (left ventricle ejection fraction (EF), diastolic dysfunction (E, E/A, E’), RV function, cardiac output, preload (LV internal dimension end diastole (LVID)), stroke volume (SV), stroke volume variation (SVV), IVC and IVC collapse. Using clinical data and defined critical care algorithm, treatment recommendations are made. We identified patients who underwent both a TTE and FREE, on same day, from January 2012 through May 2014. Bland Altmann and Pearson correlation analysis were used to assess for agreement. Clinical utility was prospectively determined by provider survey immediately following the FREE, as part of its Q/A database.ResultsOver the study period 849 FREE exams were performed. 69 patient exams met inclusion criteria. EF between groups showed a strong correlation (R= 0.89, 95% CI 0.82-0.93). Anatomic measures of LVOT, LVID, E and Lateral E’ also showed strong correlation (R=0.84, R=0.94, R=0.77, R=0.68 respectively). RV function was able to be assessed in 85% of patinets and agreed in 88% of these. Pericardial effusion evaluation agreed in 93% of patients. Aortic and mitral valve anatomy agreed in almost all patients assessed (100%, 98%). The FREE changed care in 53%, confirmed management 23%, and was found not useful in 23% of patients.ConclusionsFunctional rather than anatomically based hybrid ultrasound exams, like the FREE, provide data in a format designed to facilitate decision making in the ICU. These exams can be reliably performed by the bedside intensivist, correlate well with TTE, and may be of greater clinical value in critically ill patients. Further work is needed to determine universal applicability of these findings. ObjectivesFocused cardiac ultrasound (FCU) is commonly used to evaluate cardiac function in critically ill patients, but leaves important questions unanswered. We developed and made clinically available the Focused Rapid Echocardiographic Evaluation (FREE); a hybrid between an FCU and the quantitative anatomic assessment of standard transthoracic echocardiogram (TTE). We sought to compare the data provided by the FREE and TTE, and determine the impact of the FREE on the plan of care. Focused cardiac ultrasound (FCU) is commonly used to evaluate cardiac function in critically ill patients, but leaves important questions unanswered. We developed and made clinically available the Focused Rapid Echocardiographic Evaluation (FREE); a hybrid between an FCU and the quantitative anatomic assessment of standard transthoracic echocardiogram (TTE). We sought to compare the data provided by the FREE and TTE, and determine the impact of the FREE on the plan of care. MethodsThe FREE exam evaluates cardiac function (left ventricle ejection fraction (EF), diastolic dysfunction (E, E/A, E’), RV function, cardiac output, preload (LV internal dimension end diastole (LVID)), stroke volume (SV), stroke volume variation (SVV), IVC and IVC collapse. Using clinical data and defined critical care algorithm, treatment recommendations are made. We identified patients who underwent both a TTE and FREE, on same day, from January 2012 through May 2014. Bland Altmann and Pearson correlation analysis were used to assess for agreement. Clinical utility was prospectively determined by provider survey immediately following the FREE, as part of its Q/A database. The FREE exam evaluates cardiac function (left ventricle ejection fraction (EF), diastolic dysfunction (E, E/A, E’), RV function, cardiac output, preload (LV internal dimension end diastole (LVID)), stroke volume (SV), stroke volume variation (SVV), IVC and IVC collapse. Using clinical data and defined critical care algorithm, treatment recommendations are made. We identified patients who underwent both a TTE and FREE, on same day, from January 2012 through May 2014. Bland Altmann and Pearson correlation analysis were used to assess for agreement. Clinical utility was prospectively determined by provider survey immediately following the FREE, as part of its Q/A database. ResultsOver the study period 849 FREE exams were performed. 69 patient exams met inclusion criteria. EF between groups showed a strong correlation (R= 0.89, 95% CI 0.82-0.93). Anatomic measures of LVOT, LVID, E and Lateral E’ also showed strong correlation (R=0.84, R=0.94, R=0.77, R=0.68 respectively). RV function was able to be assessed in 85% of patinets and agreed in 88% of these. Pericardial effusion evaluation agreed in 93% of patients. Aortic and mitral valve anatomy agreed in almost all patients assessed (100%, 98%). The FREE changed care in 53%, confirmed management 23%, and was found not useful in 23% of patients. Over the study period 849 FREE exams were performed. 69 patient exams met inclusion criteria. EF between groups showed a strong correlation (R= 0.89, 95% CI 0.82-0.93). Anatomic measures of LVOT, LVID, E and Lateral E’ also showed strong correlation (R=0.84, R=0.94, R=0.77, R=0.68 respectively). RV function was able to be assessed in 85% of patinets and agreed in 88% of these. Pericardial effusion evaluation agreed in 93% of patients. Aortic and mitral valve anatomy agreed in almost all patients assessed (100%, 98%). The FREE changed care in 53%, confirmed management 23%, and was found not useful in 23% of patients. ConclusionsFunctional rather than anatomically based hybrid ultrasound exams, like the FREE, provide data in a format designed to facilitate decision making in the ICU. These exams can be reliably performed by the bedside intensivist, correlate well with TTE, and may be of greater clinical value in critically ill patients. Further work is needed to determine universal applicability of these findings. Functional rather than anatomically based hybrid ultrasound exams, like the FREE, provide data in a format designed to facilitate decision making in the ICU. These exams can be reliably performed by the bedside intensivist, correlate well with TTE, and may be of greater clinical value in critically ill patients. Further work is needed to determine universal applicability of these findings.