Echo is a core skill in caring for acutely unwell patients

Focused cardiac ultrasound is emerging as a vital tool in the armamentarium of the modern intensivist and critical care practitioner. From assessment of the patient in shock (1) to assessment of fluid status (2,3), focused echocardiography permits a deeper understanding of complex physiology in the critically ill patient. Focused cardiac ultrasound exists on the spectrum of care alongside comprehensive echocardiography, a sentiment echoed by the American Society of Echocardiography and endorsed by guidelines (4,5). A number of expert recommendations and consensus documents provide a template for which to base educational infrastructure in focused cardiac ultrasound (4,6–8). The general principles of CCUS are intertwined with focused cardiac ultrasound including:

  • Complementary or as an extension to clinical exam
  • Repeatable and non-invasive
  • Available 24/7 at the bedside
  • Goal-directed to facilitate bedside decision-making
  • Collaborative along the spectrum of care with comprehensive imaging
  • Integrated directly into the clinical context
  • Facilitate timely diagnosis and management of life-threatening pathology

Based on the above principles, our Edmonton CCUS program is developing a focused, yet rigorous curriculum in focused echocardiography for the advanced acute care provider. This section will serve as an educational repository and training base for guidance in focused echocardiography, specifically adapted for the Edmonton zone.

References

Jones AE, Tayal VS, Sullivan DM, Kline J a. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004;32(8):1703-1708.

Kanji HD, McCallum J, Sirounis D, MacRedmond R, Moss R, Boyd JH. Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. J Crit Care. 2014;29(5):700-705.

Barbier C, Loubières Y, Schmit C, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. 2004;30:1740-1746.

Via G, Hussain A, Wells M, et al. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014;27:1-33

Weigers S. President’s Message: Point of Care. Am Soc Echocardiogr News. 2016.

Cholley BP. International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37:1077-1083.

Mayo PH. American College of Chest Physicians Statement on Competence in Critical Care Ultrasonography. CHEST J. 2009;135(4):1050.

Arntfield R, Millington S, Ainsworth C, et al. Canadian recommendations for critical care ultrasound training and competency. Can Respir J. 2014;21(6):341-345.

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