Management change following transthoracic echocardiogram in the intensive care unit

The optimal utilisation of echocardiography in intensive care units (ICU) is not yet known; however, its use is becoming more frequent. Management change from transthoracic echocardiography (TTE) in ICU is quoted to be from 3% to 50%.

A retrospective review of clinical practice was performed over a 2-month period in a tertiary adult ICU, to explore the utilisation of formal TTEs and the findings of these. The rate of management change and critical findings were investigated, along with the indication for TTE and the patient cohort.

Sixty-three TTEs were performed in 54 patients. A change in management occurred in 25.4% (16/63) of TTEs, with critical findings being found in 47.6% (30/63) of all TTEs. The most common indications for formal TTEs were incompletely differentiated or further evaluation of shock, and post arrest cardiac function.

Almost half of the TTEs performed had critical findings, with common critical findings being severe LV dysfunction, severe RV dysfunction and regional wall motion abnormalities. Despite critical findings being seen frequently, there was only management change in 25%, suggesting that several of the critical findings were already suspected, clinically confirmed or had anticipatory management prior to TTE.

Critical findings are common in critically ill patients. However, not all critical findings will lead to a change in management. Formal TTEs in the ICU should be focussed to the clinical question being asked and a screening intensivist performed bedside TTE may be appropriate in certain situations to decrease workload of cardiology department.