Echocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Focus-Oriented, and Comprehensive Examination

  • Armando Sarti
  • Simone Cipani
  • Massimo Barattini


Echocardiography is applied in the emergency and ICU setting according to specific needs, at different times during the clinical course, and with different modalities. Focus-oriented or goal-directed clinical interrogation occurs any time during the clinical course of hospitalization in order to answer a specific question and guide therapy. For very unstable patients, the ultrasonographic assessment will only concentrate on the essential information that can be obtained in a few minutes or even seconds. A full, systematic assessment implies the need for substantial experience and mastery of most of the echocardiographic techniques, including TEE. In the acute phase of hemodynamic instability, the echocardiographic assessment is regularly repeated to check the clinical evolution and the response to management according to specific therapeutic goals (echocardiographic monitoring and echodynamics). In ICU echocardiography, acute changes are often superimposed on chronic alterations and remodeling. Since new-onset modification overlaps with preexisting alteration, the intensivist ultrasonography operator is faced with and must interpret a myriad of different and complex findings to obtain the general ultrasonographic morphofunctional assessment of the patient’s heart (echocardiographic history and echoanamnesis).


Echocardiographic history Goal-directed assessment Focus-oriented assessment ICU comprehensive echocardiographic examination 


  1. 1.
    Cholley BP, Vieillard-Baron A, Mebazaa A. Echocardiography in the ICU: time for widespread use! Intensive Care Med. 2005;32:9–10.CrossRefGoogle Scholar
  2. 2.
    Expert Round Table on Ultrasound in ICU. International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37:1077–83.CrossRefGoogle Scholar
  3. 3.
    Sarti A. Ecocardiografia per l’intensivista. Milan: Springer; 2009.CrossRefGoogle Scholar

Suggested Reading

  1. Breitkreutz R, Walcher F, Seeger F. Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm. Crit Care Med. 2007;35:S150–61.CrossRefGoogle Scholar
  2. Jensen MB. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol. 2004;21:700–7.CrossRefGoogle Scholar
  3. Noble VE, Nelson B, Sutingo AN. Emergency and critical care ultrasound. Cambridge: Cambridge Medicine; 2007.CrossRefGoogle Scholar
  4. Tayal VS, Kline JA. Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states. Resuscitation. 2005;59:315–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Armando Sarti
    • 1
  • Simone Cipani
    • 2
  • Massimo Barattini
    • 2
  1. 1.Department of Anesthesia and Intensive CareSanta Maria Annunziata HospitalFlorenceItaly
  2. 2.Department of Anesthesia and Intensive CareSanta Maria Nuova HospitalFlorenceItaly

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