Introduction of an Echocardiography Service to a General Intensive Care Unit

Abstract

Studies have suggested that significant undiagnosed pathology exists in the intensive care unit (ICU) population, and that bedside transthoracic echocardiography (TTE) can aid prompt diagnosis with potential outcome benefits. This study assesses the introduction of a bedside echocardiography service on patient care in a tertiary university intensive care unit (ICU). Data were collected from 101 TTEs, of which 58 were full studies and 43 were screening TTEs with a limited dataset. Seventy-five scans (74%) revealed previously undiagnosed pathology, which was considered serious in 30 (30%) cases. The most commonly diagnosed pathologies were: severe ventricular dysfunction (n=19), severe valvular dysfunction (n=9) and severe pulmonary hypertension (n=4). Full studies were more likely than screening studies to reveal previously undiagnosed pathology (47/58 vs 28/43 studies, p=0.035). However, the number of patients whose management was changed as a result of TTE was not significantly different between the two groups. Overall, patient management was altered as a result of the TTE in 51 cases (50%), and 11 patients (11%) were subsequently referred for cardiology consultation. In keeping with previous work, we have found that TTE uncovered a high percentage of unsuspected cardiac abnormalities, which impacted management in half of the patients who were scanned.