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

Abstract

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.