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KEY POINTS

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KEY POINTS

  1. The frontline intensivist uses echocardiography on a routine basis to aid in the diagnosis and management of patients with hemodynamic failure.

  2. Critical care echocardiography (CCE) is divided into basic and advanced levels of competency, with this chapter focusing on the fundamentals of basic CCE.

  3. The basic CCE examination comprises five standard transthoracic echocardiography (TTE) views: PSL, PSS, AP4, SCL, and IVC longitudinal axis.

  4. The intensivist performing basic CCE is capable of acquiring and interpreting the necessary images, has a strong foundation in the cognitive aspects of CCE, and understands the pitfalls inherent to the various echocardiographic views.

  5. Transesophageal echocardiography may be used within the scope of the basic CCE. It is typically used when TTE image quality is suboptimal.

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INTRODUCTION

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Echocardiography has major applications in the intensive care unit (ICU) for rapid assessment of the patient with hemodynamic failure. Critical care echocardiography (CCE) is an essential skill for the frontline intensivist. This chapter will review key aspects of CCE with emphasis on the basic CCE examination.

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LEVELS OF COMPETENCE

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The American College of Chest Physicians/Société de Réanimation de Langue Française (ACCP/SRLF) statement on competence in critical care ultrasonography divides CCE competency into basic and advanced levels.1 Basic CCE requires competence in a limited number of transthoracic echocardiography (TTE) views with an option to use limited transesophageal echocardiography (TEE). Basic CCE is a fundamental skill for all intensivists, and requires a relatively short training period. Competence in advanced CCE requires the intensivist to have a skill level comparable to a cardiology trained echocardiographer in both TTE and TEE, and requires a long training period by comparison to basic TTE.2,3 Only a small proportion of intensivists need this level of skill, so this chapter will focus on basic CCE. The Accreditation Council of Graduate Medical Education has recently established that knowledge of critical care ultrasonography is a mandatory component of critical care fellowship training in the United States.4 Within a few years, all graduating fellows will be competent in this essential skill; attending level intensivists will need to develop competence in basic CCE as well.

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TRAINING

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Competence in basic CCE requires training. Noncardiologists can become competent in basic CCE.5 Exact requirements for training methods have not been standardized, but a recent statement suggests that basic CCE training include at least 10 hours of course work (comprised of lectures, didactic cases, and image interpretation) and a minimum of 30 fully supervised TTE studies (image acquisition and interpretation).2 While these numbers offer some guidance, they do not guarantee that the trainee is sufficiently trained. Competency based testing at the end of the training period provides assurance that the clinician has achieved the requisite skill. Competence in basic CCE includes the ability to acquire and interpret the necessary images, but also mastery of the cognitive elements ...

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