Skip to main content
The Egyptian Journal of Bronchology
Download PDF
  • Original article
  • Open access
  • Published:

The utility of integrating basic echocardiography in routine respiratory intensive care practice

Egyptian Journal of Bronchology volume 12, pages 433–447 (2018)Cite this article

Abstract

Objective

The aim of this study was to evaluate the impact of integrating basic echocardiography in routine assessment of patients admitted to the respiratory intensive care unit and to assess its effect on the outcome of those patients.

Patients and methods

This prospective cross-sectional study was performed upon 300 patients admitted to the respiratory intensive care unit between January 2015 and December 2015 at Abbasia Chest Hospital. Baseline bedside scanning of patients on admission by portable echo machine for basic echocardiography was reviewed by an experienced cardiologist in all cases as gold standard. Basic echocardiography was done to assess the pericardium, left and right ventricular size and function, valvular lesions, and inferior vena cava. Limited compression ultrasonography was done to detect lower limb deep venous thrombosis (DVT).

Results

Basic echocardiography showed that 91/300 (30.3%) patients had normal echocardiogram, whereas 209/300 (69.7%) patients had cardiac abnormalities. Basic echocardiography added unsuspected serious conditions to the diagnosis in 33 (11%) patients; five patients with massive pericardial effusion, 22 patients who required inotropics due to dilated cardiomyopathy in 11 patients and ischemic cardiomyopathy in 11 patients, five patients with DVT, and one patient with aortic aneurysm. In addition to this, basic echocardiography confirmed suspected massive pulmonary embolism in seven patients and DVT in 13 patients. Basic echo was able to read the whole finding data as compared to standard echo, with mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 93, 97, 97, 98, and 98%, respectively, except for probable incompetent and probable normal tricuspid valve; the standard echo had the upper hand (P<0.0001).

Conclusion

Basic echocardiography in critically ill patients can readily provide adequate information to get a successful diagnosis and management, especially in life-threatening conditions that can be missed at the primary assessment.

References

  1. Ruiz-Bailén M, Romero-Bermejo FJ, Ramos-Cuadra JÁ, Rucabado-Aguilar L, Chibouti-Bouichrat K, et al. Evaluation of the performance of echocardiography in acute coronary syndrome patients during their stay in coronary units. Acute Card Care 2011;13:21–29.

    Article  Google Scholar 

  2. Manasia AR, Nagaraj HM, Kodali RB, Croft LB, Oropello JM, Kohli-Seth R, et al. Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by non cardiologist intensivists using a small hand-carried device (Sono Heart) in critically ill patients. J Cardiothorac Vasc Anesth 2005;19:155–159.

    Article  Google Scholar 

  3. Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, et al. Focused cardiac ultrasound in the emergent setting:a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 2010;23:1225–1230.

    Article  Google Scholar 

  4. Jones AE, Tayal VS, Kline JA. Focused training of emergency medicine residents in goal-directed echocardiography:a prospective study. Acad Emerg Med 2003;10:1054–1058.

    Article  Google Scholar 

  5. Kosiak W, Swieton D, Piskunowicz M. Sonographic inferior vena cava/aorta diameter index, a new approach to the body fluid status assessment in children and young adults in emergency ultrasound preliminary study. Acad J Emerg Med 2008;26:320–325.

    Google Scholar 

  6. Farahmand S, Farnia M, Shahriaran S, Khashayar P. The accuracy of limited B-mode compression technique in diagnosing deep venous thrombosis in lower extremities. Am J Emerg Med 2011;29:687–690.

    Article  Google Scholar 

  7. Casaroto E, Mohovic T, Pinto LM, Rodrigues de Lara T. Bedside echocardiography in critically ill patients. Einstein (Sao Paulo) 2015;13:644–646.

    Article  Google Scholar 

  8. Dresden S, Mitchell P, Rahimi L, Leo M, Rubin-Smith J, Bibi S, et al. Right ventricular dilatation on bedside echocardiography performed by emergency physicians aids in the diagnosis of pulmonary embolism. Ann Emerg Med 2014;63:16–24.

    Article  Google Scholar 

  9. Weekes AJ, Thacker G, Troha D, Johnson AK, Chanler-Berat J, Norton HJ, Runyon M. Diagnostic accuracy of right ventricular dysfunction markers in normotensive emergency department patients with acute pulmonary embolism. Ann Emerg Med 2016;68:277–291.

    Article  Google Scholar 

  10. Cho JH, Sridharan GK, Kim SH, Kaw R, Abburi T, Irfan A, Kocheril AG. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism:a meta-analysis. BMC Cardiovasc Disord 2014; 14:64.

    Article  Google Scholar 

  11. Laursen CB, Sloth E, Lambrechtsen J, Lassen AT, Madsen PH, Henriksen DP, et al. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest 2013;144:1868–1875.

    Article  Google Scholar 

  12. Alexander JH, Peterson ED, Chen AY, Harding TM, Adams DB, Kisslo JA. Feasibility of point-of-care echocardiography by internal medicine house staff. Am Heart J 2004;147:476–481.

    Article  Google Scholar 

  13. Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med 2002;9:186–193.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Chest Diseases, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Magdy M. Khalil, Iman H. E. Galal & Ashraf A. El-Maraghy

  2. Department of Cardiac Diseases, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Ghada S. El-Shahid

  3. Department of Pulmonology, Zagazig Chest Hospital, 44511, Zagazig, Egypt

    Hanan H. I. Mahmoud

Authors
  1. Magdy M. Khalil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ghada S. El-Shahid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Iman H. E. Galal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashraf A. El-Maraghy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hanan H. I. Mahmoud
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hanan H. I. Mahmoud.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khalil, M.M., El-Shahid, G.S., Galal, I.H.E. et al. The utility of integrating basic echocardiography in routine respiratory intensive care practice. Egypt J Bronchol 12, 433–447 (2018). https://doi.org/10.4103/ejb.ejb_8_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_8_18

Keywords