In the Aarhus University Hospital departments of intensive care it is routinely performed in unstable and septic patients.
I have not observed TTE used routinely on patients admitted for shock. That being said, if there is a question about endocarditis, then TEE (trans-esophageal echocardiography) is more sensitive to visualize any valvular vegetation (especially the tricuspid valve). However, TTE may be useful if there is a question on what type of shock is going on in the ED. If there is a very low cardiac output then cardiogenic shock may be the cause. If there is cardiac tamponade then that should be easily observed on TTE. If there is high-output shock with a hyperdynamic profile, then septic shock may be the cause. If the type of shock is easily delineated in the differential diagnosis, then a TTE may not be that useful. The only other time that I have seen the TTE used on admitted patients for shock is if the patient has an existing cardiac history and especially if the patient is known to have a low ejection fraction. Hope that answers your question.
Yes on our 16-bedded ICU it is routine practice to do a TTE on all patients with shock, starting with a limited and focused study and proceed to a full evaluation.
yes. since most of the patients admitted in our center, have an existing cardiac history, or they are known heart failure cases with low EF, so using TTE and TEE is routine.
Hi Tomasz
There is not mandatory TTE in the ICU admitted patients because of low sensitivity compared with TEE especially post operative cardiac surgical patients. Then we offer TEE.
With Great Thanks
Hi Tomasz,
I think you may find the Consensus statement of the ESICM very useful. Echocardiography is recommended as first line monitoring assessment in patients with shock.
It is also recommended in another statement of the ESICM that all critical care doctors should be competent in basic critical care echocardiography. Indeed, the ESICM has launched the new European Diploma of Echocardiography
http://www.esicm.org/education/edec
Best regards,
Filippo
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