From ICCU to ICU bedside Echocardiography !
However, Bedside transthoracic echocardiography (TTE) provides rapid and noninvasive hemodynamic assessment of critically ill patients but is limited by the immediate availability of experienced sonographer .Noncardiologists are able to estimate LV function with reasonable accuracy using a hand-held unit in the ICU ,but, indeed, noncardiologists often fail to identify important cardiac abnormalities such as valvular disease and regional wall abnormalities, important cardiac causes of hemodynamic compromise such as cor pulmonale, acute valvular abnormalities, and intracardiac shunts as well as very complicated cases rather than LV function determination only .
Its training should be mandatory for all intensivists and anesthesiologist because it is of particular importance .
For example,respiratory variation in inferior vena cava diameter may help predict the likelihood of fluid responsiveness, and measurement of flow across the aortic valve can be used to estimate cardiac output and calculate systemic vascular resistance.
Inotropic therapy might be withheld from patients with hemodynamic impairment resulting from decreased LV function if the TTE was misinterpreted as normal. Conversely, a patient with normal LV function whose hypotension was due to hypovolemia or vasodilation might be inappropriately treated with an inotrope if LV function was incorrectly deemed to be abnormal. in a daily basis , the most common error was failure to recognize a decrease in LV function rather than misinterpreting normal LV function as abnormal.