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Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View

In critically ill patients, standard transthoracic echocardiography (TTE) generally does not facilitate good image quality during mechanical ventilation. We propose a prone-TTE in prone positioned patients, which allows clinicians to obtain a complete apical four-chamber (A-4-C) view. A basic cardia...

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Autores principales: Giustiniano, Enrico, Palma, Sergio, Meco, Massimo, Ripani, Umberto, Nisi, Fulvio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221662/
https://www.ncbi.nlm.nih.gov/pubmed/35741270
http://dx.doi.org/10.3390/diagnostics12061460
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author Giustiniano, Enrico
Palma, Sergio
Meco, Massimo
Ripani, Umberto
Nisi, Fulvio
author_facet Giustiniano, Enrico
Palma, Sergio
Meco, Massimo
Ripani, Umberto
Nisi, Fulvio
author_sort Giustiniano, Enrico
collection PubMed
description In critically ill patients, standard transthoracic echocardiography (TTE) generally does not facilitate good image quality during mechanical ventilation. We propose a prone-TTE in prone positioned patients, which allows clinicians to obtain a complete apical four-chamber (A-4-C) view. A basic cardiac assessment can be performed in order to evaluate right ventricle function and left ventricle performance, even measuring objective parameters, i.e., tricuspid annular plane systolic excursion (TAPSE); pulmonary artery systolic pressure (PAP), from the tricuspid regurgitation peak Doppler velocity; RV end-diastolic diameter and its ratio to left ventricular end-diastolic diameter; the S’ wave peak velocity with tissue Doppler imaging; the ejection fraction (EF); the mitral annular plane systolic excursion (MAPSE); diastolic function evaluation by the mitral valve; and annular Doppler velocities. Furthermore, by tilting the probe, we can obtain the apical-five-chamber (A-5-C) view, which facilitates the analysis of blood flow at the level of the output tract of the left ventricle (LVOT) and then the estimation of stroke volume. Useful applications of this technique are hemodynamic assessment, titration of fluids, vasoactive drugs therapy, and evaluation of the impact of prone positioning on right ventricle performance and right pulmonary resistances. We believe that considerable information can be drawn from a single view and hope this may be helpful to emergency and critical care clinicians whenever invasive hemodynamic monitoring tools are not available or are simply inconvenient due to clinical reasons.
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spelling pubmed-92216622022-06-24 Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View Giustiniano, Enrico Palma, Sergio Meco, Massimo Ripani, Umberto Nisi, Fulvio Diagnostics (Basel) Review In critically ill patients, standard transthoracic echocardiography (TTE) generally does not facilitate good image quality during mechanical ventilation. We propose a prone-TTE in prone positioned patients, which allows clinicians to obtain a complete apical four-chamber (A-4-C) view. A basic cardiac assessment can be performed in order to evaluate right ventricle function and left ventricle performance, even measuring objective parameters, i.e., tricuspid annular plane systolic excursion (TAPSE); pulmonary artery systolic pressure (PAP), from the tricuspid regurgitation peak Doppler velocity; RV end-diastolic diameter and its ratio to left ventricular end-diastolic diameter; the S’ wave peak velocity with tissue Doppler imaging; the ejection fraction (EF); the mitral annular plane systolic excursion (MAPSE); diastolic function evaluation by the mitral valve; and annular Doppler velocities. Furthermore, by tilting the probe, we can obtain the apical-five-chamber (A-5-C) view, which facilitates the analysis of blood flow at the level of the output tract of the left ventricle (LVOT) and then the estimation of stroke volume. Useful applications of this technique are hemodynamic assessment, titration of fluids, vasoactive drugs therapy, and evaluation of the impact of prone positioning on right ventricle performance and right pulmonary resistances. We believe that considerable information can be drawn from a single view and hope this may be helpful to emergency and critical care clinicians whenever invasive hemodynamic monitoring tools are not available or are simply inconvenient due to clinical reasons. MDPI 2022-06-14 /pmc/articles/PMC9221662/ /pubmed/35741270 http://dx.doi.org/10.3390/diagnostics12061460 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Giustiniano, Enrico
Palma, Sergio
Meco, Massimo
Ripani, Umberto
Nisi, Fulvio
Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View
title Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View
title_full Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View
title_fullStr Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View
title_full_unstemmed Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View
title_short Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View
title_sort echocardiography in prone positioned critically ill patients: a wealth of information from a single view
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221662/
https://www.ncbi.nlm.nih.gov/pubmed/35741270
http://dx.doi.org/10.3390/diagnostics12061460
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