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Del Castillo C, Verdugo F, Appiani F, Yáñez F, Bontá C, Torres-Herrera C, Garcia A, Blázquez-Bermejo Z, Castrodeza J, Requena D, Rodríguez A, Silvio A, Gatica A, Begazo A, Alfaro M. Echocardiogram by apical-subcostal protocol in prone position during invasive mechanical ventilation in cardiovascular intensive care unit. Cardiovasc Ultrasound 2024; 22:7. [PMID: 38858752 PMCID: PMC11163713 DOI: 10.1186/s12947-024-00326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
AIMS To evaluate the feasibility of a transthoracic echocardiogram using an apical-subcostal protocol in invasive mechanical ventilation (IMV) and prone position. METHODS Prospective study of adults who required a prone position during IMV. A pillow was placed only under the left hemithorax in the prone position to elevate and ease the apical and subcostal windows. A critical care cardiologist (prone group) acquired and evaluated the images using the apical-subcostal protocol. Besides, we used ambulatory echocardiograms performed as a comparative group (supine group). RESULTS 86 patients were included, 43 in the prone and 43 in the supine. In the prone group, the indication to perform an echocardiogram was hemodynamic monitoring. All patients were ventilated with protective parameters, and the mean end-expiratory pressure was 10.6 cmH2O. The protocol was performed entirely in 42 of 43 patients in the prone group because one patient did not have any acoustic window. In the 43 patients in the prone group analyzed and compared to the supine group, global biventricular function was assessed in 97.7% (p = 1.0), severe heart valve disease in 88.4% (p = 0.055), ruled out of the presence of pulmonary hypertension in 76.7% (p = 0.80), pericardial effusion in 93% (p = 0.12), and volume status by inferior vena cava in 93% (p = 0.48). Comparing prone versus supine position, a statistical difference was found when evaluating the left ventricle apical 2-chamber view (65.1 versus 100%, p < 0.01) and its segmental function (53.4 versus 100%, p < 0.01). CONCLUSION The echocardiogram using an apical-subcostal protocol is feasible in patients in the IMV and prone position.
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Affiliation(s)
- César Del Castillo
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile.
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile.
| | | | - Franco Appiani
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Francisca Yáñez
- Cardiovascular department, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Camila Bontá
- Cardiovascular department, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Carlos Torres-Herrera
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Angela Garcia
- Intensive Care Unit, Hospital DIPRECA, Santiago, Chile
| | - Zorba Blázquez-Bermejo
- Cardiovascular department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Castrodeza
- Cardiovascular department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel Requena
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
| | | | - Arquimedes Silvio
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Agustín Gatica
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
| | - Arnulfo Begazo
- Cardiovascular department, Hospital DIPRECA, Santiago, Chile
- Postgraduate Department, Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Mario Alfaro
- Cardiovascular department, Hospital Clínico San Borja Arriarán, Santiago, Chile
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Gifari MW, Hassan M, Suzuki K. Teleoperated Probe Manipulator for Prone-Position Echocardiography Examination. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4350-4353. [PMID: 36086338 DOI: 10.1109/embc48229.2022.9871021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Echocardiography probe manipulation is a strenuous task. During a procedure, the operator must hold the probe, extend their arm, bend their elbow, and monitor the resulting image simultaneously, which causes strain and introduces variability to the measurement. We propose a teleoperated probe manipulation robot to reduce the burden of handling the probe and minimize the infection risk during the COVID pandemic. The proposed robot utilizes prone position scanning that could enlarge the cardiac windows for easier scanning and eliminate the risk of the robot pressing down on the patient. We derived the robot's requirements based on a real clinical scenario. Initial evaluation showed that the robot could achieve the required range of motion, force, and control. The robot's functionality was tested by a non-clinician, in which the tester could obtain heart images of a volunteer in under one minute.
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Giustiniano E, Palma S, Meco M, Ripani U, Nisi F. Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View. Diagnostics (Basel) 2022; 12:diagnostics12061460. [PMID: 35741270 PMCID: PMC9221662 DOI: 10.3390/diagnostics12061460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023] Open
Abstract
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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Affiliation(s)
- Enrico Giustiniano
- Department of Anesthesia, Intensive Care Unit and Pain Therapy, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy; (E.G.); (S.P.)
| | - Sergio Palma
- Department of Anesthesia, Intensive Care Unit and Pain Therapy, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy; (E.G.); (S.P.)
| | - Massimo Meco
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni Clinics, Via Mauro Gavazzeni, 21, 24125 Bergamo, Italy;
| | - Umberto Ripani
- Division of Clinic Anaesthesia, Department of Emergency Hospital Riuniti, Conca Street 71, 60126 Ancona, Italy;
| | - Fulvio Nisi
- Department of Anesthesia, Intensive Care Unit and Pain Therapy, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy; (E.G.); (S.P.)
- Correspondence: ; Tel.: +39-02-8224-4115; Fax: +39-02-8224-4190
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Soliman-Aboumarie H, Pastore MC, Galiatsou E, Gargani L, Pugliese NR, Mandoli GE, Valente S, Hurtado-Doce A, Lees N, Cameli M. Echocardiography in the intensive care unit: An essential tool for diagnosis, monitoring and guiding clinical decision-making. Physiol Int 2021. [PMID: 34825894 DOI: 10.1556/1647.2021.00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
In the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac diseases such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been increasing use of positive pressure mechanical ventilation which has its implications on the heart. Therefore, there is a growing need for Cardiac intensivists to quickly, noninvasively and repeatedly evaluate various hemodynamic conditions and the response to therapy. Transthoracic critical care echocardiography (CCE) currently represents an essential tool in CICU, as it is used to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular pathologies, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with trans-esophageal echocardiography (TOE), advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making.
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Affiliation(s)
- Hatem Soliman-Aboumarie
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
- 4 School of Cardiovascular Sciences and Medicine, King's College, London , United Kingdom
| | - Maria Concetta Pastore
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Eftychia Galiatsou
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
| | - Luna Gargani
- 3 Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Giulia Elena Mandoli
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ana Hurtado-Doce
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
| | - Nicholas Lees
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
| | - Matteo Cameli
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Jaglan A, Kaminski A, Payne A, Salinas PD, Khandheria BK. Focus, Not Point-of-Care, Echocardiography in Prone Position: It Can Be Done in COVID-19 Patients. ACTA ACUST UNITED AC 2020; 5:53-55. [PMID: 33134650 PMCID: PMC7587073 DOI: 10.1016/j.case.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Prone positioning improves oxygenation in patients with ARDS. Reducing RV dysfunction is vital to decrease mortality. Prone positioning may assist cardiac function by offloading pressure from the RV.
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Affiliation(s)
- Akshar Jaglan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Abby Payne
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Pedro D Salinas
- Aurora Critical Care Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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