Echocardiography in the Critical Care Unit

  • Anita Sadeghpour
  • Azin Alizadehasl


Transthoracic echocardiography (TTE) has been incorporated effectively into patient care in 90% of critically ill patients. However, despite its advantages in terms of its noninvasive nature, the quality of the images may be insufficient-particularly in chest traumas and intrathoracic surgery. That is why transesophageal echocardiography (TEE) has replaced TTE in the intensive care unit (ICU), especially in patients with an endotracheal tube. Even now, there is a broad range of echo applications available to ICU physicians to enhance and improve their care of critically ill patients, with many new applications on their way.


Transthoracic echocardiography (TTE) Transesophageal echocardiography (TEE) Critical Care Unit Intensive care unit (ICU) Cardiac arrest Aortic dissection Tamponade Pulmonary emboli 



Cardiac output


Cardiopulmonary resuscitation


Ejection fraction


Intensive care unit


Left ventricular


Left ventricular end-diastolic


Left ventricular end-systolic


Left ventricular outflow tract


Pulmonary thromboembolism


Right ventricular


Right ventricular outflow tract


Systolic anterior motion


Stroke volume


Transesophageal echocardiography


Transthoracic echocardiography


Velocity time integral

Supplementary material

Movie 32.1

(related to Fig. 32.2): Large circumferential pericardial effusion and classic RV free wall diastolic collapse (AVI 3591 kb)

Movie 32.2

(related to Fig. 32.4): TEE from an Type A extended acute aortic dissection that transferred directly to the operating room (WMV 6374 kb)


  1. 1.
    Royse CF, Seah JL, Donelan L, Royse AG. Point of care ultrasound for basic haemodynamic assessment: novice compared with an expert operator. Anaesthesia. 2006;61:849–55.CrossRefGoogle Scholar
  2. 2.
    Lemola K, Yamada E, Jagasia D, Kerber RE. A hand-carried personal ultrasound device for rapid evaluation of left ventricular function: use after limited echo training. Echocardiography. 2003;20:309.CrossRefGoogle Scholar
  3. 3.
    Stewart WJ, Douglas PS, Sagar K, Seward JB, Armstrong WF, Zoghbi W, Kronzon I, Mays JM, Pearlman AS, Schnittger I, St Vrain JA, Kerber RE. Echocardiography in emergency medicine: a policy statement by the American Society of Echocardiography and the American College of Cardiology. The Task Force on Echocardiography in Emergency Medicine of the American Society of Echocardiography and the Echocardiography TPEC Committees of the American College of Cardiology. J Am Soc Echocardiogr. 1999;12:82–4.CrossRefGoogle Scholar
  4. 4.
    Kallmeyer IJ, Collard CD, Fox JA, Body SC, Shernan SK. The safety of transesophageal echocardiography: a case series of 7200 cardiac surgical patients. Anesth Analg. 2001;92:1126–30.CrossRefGoogle Scholar
  5. 5.
    Benjamin E, Griffin K, Leibowitz AB, et al. Goal-directed transesophageal echocardiography performed by intensivist to assess left ventricular function: comparison with pulmonary artery catheterization. J Cardiothorac Vasc Anesth. 1998;12:10–5.CrossRefGoogle Scholar
  6. 6.
    Karski JM. Transesophageal echocardiography in the intensive care unit. Semin Cardiothorac Vasc Anesth. 2006;10:162–6.CrossRefGoogle Scholar
  7. 7.
    Vignon P, Mentec H, Terré S, Gastinne H, Gueret P, Lemaire F. Diagnostic accuracy and therapeutic impact of transthoracic and transesophageal echocardiography in mechanically ventilated patients in the ICU. Chest. 1994;106(6):1829–34.CrossRefGoogle Scholar
  8. 8.
    Chew MS. Haemodynamic monitoring using echocardiography in the critically Ill: a review. Cardiol Res Pract. 2012;2012:139537. Scholar
  9. 9.
    Mayo PH, Narasimhan M, Koenig S. Critical care transesophageal echocardiography. Chest. 2015;148(5):1323–32. Scholar
  10. 10.
    Thys DM, Abel M, Brooker RF, Cahalan MK, Connis R, Duke P, et al. Practice guidelines for perioperative transesophageal echocardiography. Anesthesiology. 2010;112:1084–96.Google Scholar
  11. 11.
    Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.CrossRefGoogle Scholar
  12. 12.
    Randazzo M, Snoey E, Levitt M, Binder K. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med. 2003;10(9):973–7.CrossRefGoogle Scholar
  13. 13.
    Mann H, Nolan P. Update on the management of cardiogenic shock. Curr Opin Crit Care. 2006;2(5):431–6.CrossRefGoogle Scholar
  14. 14.
    Melamed R, Sprenkle M, Ulstad V, Herzog C, Leatherman J. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest. 2009;135(6):1416–20.CrossRefGoogle Scholar
  15. 15.
    Moore C, Rose G, Tayal V, Sullivan D, Arrowood J, Kline J. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med. 2002;9(3):186–93.CrossRefGoogle Scholar
  16. 16.
    Gunst M, Ghaemmaghami V, Sperry J, et al. Accuracy of cardiac function and volume status estimates using the bedside echocardiographic assessment in trauma/critical care. J Trauma. 2008;65(3):509.CrossRefGoogle Scholar
  17. 17.
    Porter T, Shillcutt S, Adams M, Desjardins G, Glas K, Olson J, et al. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2015;28:40–56.CrossRefGoogle Scholar
  18. 18.
    Guberman B, Fowler N, Engel P, Gueron M, Allen J. Cardiac tamponade in medical patients. Circulation. 1981;64(3):633–40.CrossRefGoogle Scholar
  19. 19.
    Mandavia D, Hoffner R, Mahaney K, Henderson S. Bedside echocardiography by emergency physicians. Ann Emerg Med. 2001;38(4):377–82.CrossRefGoogle Scholar
  20. 20.
    Blaivas M. Incidence of pericardial effusion in patients presenting to the emergency department with unexplained dyspnea. Acad Emerg Med. 2001;8(12):1143–6.CrossRefGoogle Scholar
  21. 21.
    Wells P, Anderson D, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98–107.CrossRefGoogle Scholar
  22. 22.
    Ceylan N, Tasbakan S, Bayraktaroglu S, et al. Predictors of clinical outcome in acute pulmonary embolism. Correlation of CT pulmonary angiography with clinical, echocardiography and laboratory findings. Acad Radiol. 2011;18(1):47–53.CrossRefGoogle Scholar
  23. 23.
    Kapoor MC. Systolic anterior motion of the mitral valve in hypovolemia and hyper-adrenergic states. Indian J Anaesth. 2014;58(1):7–8.CrossRefGoogle Scholar
  24. 24.
    Nienaber C, von K, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. 1993;328(1):1–9.CrossRefGoogle Scholar
  25. 25.
    Budhram G, Reardon R. Diagnosis of ascending aortic dissection using emergency department bedside echocardiogram. Acad Emerg Med. 2008;15(6):584.CrossRefGoogle Scholar
  26. 26.
    Perkins A, Liteplo A, Noble V. Ultrasound diagnosis of type A aortic dissection. J Emerg Med. 2010;38(4):490–3.CrossRefGoogle Scholar
  27. 27.
    Vignon P, Spencer K, Rambaud G, et al. Differential transesophageal echocardiographic diagnosis between linear artifacts and intraluminal flap of aortic dissection or disruption. Chest. 2001;119(6):1778–90.CrossRefGoogle Scholar
  28. 28.
    Jones A, Craddock P, Tayal V, Kline J. Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension. Shock. 2005;24(6):513–7.CrossRefGoogle Scholar
  29. 29.
    Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Hemodynamic instability in sepsis: bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med. 2003;168(11):1270–6.CrossRefGoogle Scholar
  30. 30.
    Meyer D, Jessen M, Grayburn P. Use of echocardiography to detect occult cardiac injury after penetrating thoracic trauma: a prospective study. J Trauma. 1995;39(5):902–7.CrossRefGoogle Scholar
  31. 31.
    Speight J, Sanders M. Pericardial tamponade with a positive abdominal FAST scan in blunt chest trauma. J Trauma. 2006;61(3):743.CrossRefGoogle Scholar
  32. 32.
    Baxa M. Cardiac rupture secondary to blunt trauma: a rapidly diagnosable entity with two-dimensional echocardiography. Ann Emerg Med. 1991;20(8):902–4.CrossRefGoogle Scholar
  33. 33.
    Blaivas F. Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram. Ann Emerg Med. 2001;8(6):616–21.Google Scholar
  34. 34.
    Testa A, Cibinel G, Portale G, et al. The proposal of an integrated ultrasonographic approach into the ALS algorithm for cardiac arrest: the PEA protocol. Eur Rev Med Pharmacol Sci. 2010;14(2):77–88.PubMedGoogle Scholar
  35. 35.
    Hernandez C, Shuler K, Hannan H, Sonyika C, Likourezos A, Marshall J. CAUSE: Cardiac arrest ultra-sound exam—a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation. 2008;76(2):198–206.CrossRefGoogle Scholar
  36. 36.
    Morrison L, Deakin C, Morley P, et al. Part 8: advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation. 2010;122(Suppl 2):S345–421.CrossRefGoogle Scholar
  37. 37.
    Blyth L. Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review. Acad Emerg Med. 2012;19(10):1119–26.CrossRefGoogle Scholar
  38. 38.
    Parker M, Cunnion R, Parrillo J. Echocardiography and nuclear cardiac imaging in the critical care unit. JAMA. 1985;254(20):2935–9.CrossRefGoogle Scholar
  39. 39.
    Vieillard-Baron A, Qanadli SD, Antakly Y, et al. Transesophageal echocardiography for the diagnosis of pulmonary embolism with acute cor pulmonale: a comparison with radiological procedures. Intensive Care Med. 1998;24(5):429–33.CrossRefGoogle Scholar
  40. 40.
    Jardin F, Vieillard-Baron A. Right ventricular function and positive pressure ventilation in clinical practice: from hemodynamic subsets to respirator settings. Intensive Care Med. 2003;29(9):1426–34.CrossRefGoogle Scholar
  41. 41.
    Yeh YL, Liu CK, Chang WK, Chan KH, Li JY, Tsai SK. Detection of right to left shunt by transesophageal echocardiography in a patient with postoperative hypoxemia. J Formos Med Assoc. 2006;105(5):418–21.CrossRefGoogle Scholar
  42. 42.
    Michard F, Teboul JL. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation. Crit Care. 2000;4(5):282–9.CrossRefGoogle Scholar
  43. 43.
    Gernoth C, Wagner G, Pelosi P, Luecke T. Respiratory and haemodynamic changes during decremental open lung positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. Crit Care. 2009;13(2):R59.CrossRefGoogle Scholar
  44. 44.
    Lamia B, Maizel J, Ochagavia A, et al. Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med. 2009;37(5):1696–701.CrossRefGoogle Scholar
  45. 45.
    Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30(6):1527–33.CrossRefGoogle Scholar
  46. 46.
    Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: clinical investigation and reports. Circulation. 2000;102:1788–94.CrossRefGoogle Scholar
  47. 47.
    Bouhemad B, Nicolas-Robin A, Benois A, Lemaire S, Goarin JP, Rouby JJ. Echocardiographic Doppler assessment of pulmonary capillary wedge pressure in surgical patients with postoperative circulatory shock and acute lung injury. Anesthesiology. 2003;98(5):1091–100.CrossRefGoogle Scholar
  48. 48.
    Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107–33.CrossRefGoogle Scholar
  49. 49.
    Lamia B, Ochagavia A, Monnet X, Chemia D, Richard C, Teboul JL. Echocardiographic prediction of volume responsiveness to critically ill patients with spontaneous breathing activity. Intensive Care Med. 2007;33:1125–32.CrossRefGoogle Scholar
  50. 50.
    Vignon P, AitHssain A, François B, et al. Echocardiographic assessment of pulmonary artery occlusion pressure in ventilated patients: a transoesophageal study. Crit Care. 2008;12(1):R18.CrossRefGoogle Scholar
  51. 51.
    Poelaert J, Schmidt C, Van Aken H, Hinder F, Mollhoff T, Loick HM. A comparison of transoesophageal echocardiographic Doppler across the aortic valve and the thermodilution technique for estimating cardiac output. Anaesthesia. 1999;54(2):128–36.CrossRefGoogle Scholar
  52. 52.
    Pinsky MR. Assessment of indices of preload and volume responsiveness. Curr Opin Crit Care. 2005;11(3):235–9.CrossRefGoogle Scholar
  53. 53.
    Vieillard-Baron A, Chergui K, Rabiller A, et al. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med. 2004;30(9):1734–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Anita Sadeghpour
    • 1
  • Azin Alizadehasl
    • 2
  1. 1.Professor of CardiologyEchocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical ScienceTehranIran
  2. 2.Associate Professor of Cardiology, Echocardiologist, Echocardiography and Cardiogenetic Research CentersCardio-Oncology Department, Rajaie Cardiovascular Medical and Research CenterTehranIran

Personalised recommendations