Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Diagnostic ultrasound standards for management of patients in the division of resuscitation and intensive care

Authors: L.A. Bockeria, M.M. Alshibaya, N.O. Sokol'skaya, A.A. Rakhimov, N.S. Kopylova

Company:
A.N. Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Medical Science, Rublevskoe shosse, 135, Moscow, 121552, Russia

Link: Clinical Physiology of Blood Circulaiton. 2013; (): -

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Abstract

Objective of the study is to present the analysis of performance of emergency diagnostic ultrasound services in the division of resuscitation and intensive therapy of cardiovascular surgery clinic that provides technologically advanced care, and to determine the possibilities to use the standards of diagnostic ultrasound examination in intensive care in patients who underwent surgery for ischemic heart disease and post-infarction left ventricular aneurysm. Material and methods. The study included 102 patients with coronary artery disease and post-infarction left ventricular aneurysm who underwent myocardial revascularization and left ventricular geometry reconstruction by endoventricular circular patch plasty repair. Majority of patients had a smooth post-operative course – they were included in group I, group II was composed of 12 patients with complicated course. Results. Echocardiographic indices of the functional state of the left ventricular myocardium in an early post-operative period in group I patients indicated an adequate myocardial response to the surgical correction performed and appeared to be the favourable prognostic factors. Breakdown of adaptive processes and compensatory mechanisms of left ventricular myocardium was observed in group II patients in an early post-operative period, that was characterized by a number of echocardiographic parameters. Patients who had a smooth post-operative course stayed in Resuscitation and Intensive Care Unit within 24 to 48 hours and two diagnostic ultrasound procedures on average – echocardiography and ultrasound examination of the pleura were performed on each patient daily. Patients with complicated course in Resuscitation and Intensive Care Unit had more than two ultrasound examinations, the total number of ultrasound scans performed per one patient ranged from 20 to 40. The largest number of ultrasound examinations were performed on 3d–9th post-operative day, the rate of further ultrasound monitoring didn't exceed 2 scans per day. Conclusion. Diagnostic ultrasound standards for patients who have a smooth early post-operative course must include focused echocardiography and ultrasound examination of pleural cavities – before surgery and before transfer from the Resuscitation and Intensive Care Unit. Additional ultrasound protocols of organs and body systems must be used for patients who have complicated early post-operative course and multiple organ dysfunction syndrome depending on the form of pathology developed. All patients with congestive heart failure must undergo clinically indicated extended and repeated echocardiographic examination which enables a detailed dynamic assessment of the functional state of the heart and circulatory system taken as a whole.

References

1. Бокерия Л.А., Голухова Е.З., Иваницкий А.В. Функциональная диагностика в кардиологии. М.: НЦССХ им. А.Н. Бакулева РАМН; 2002. 2. Бокерия Л.А., Голухова Е.З. Клиническая кардиология. М.: НЦССХ им. А.Н. Бакулева РАМН; 2011. 3. Бокерия Л.А., Малашенков А.И., Сокольская Н.О. Возможности и значение различных методов эхокардиографии у больных с аневризмой аорты до и в ранние сроки после хирургического лечения. Грудная и сердечно-сосудистая хирургия. 2007; 5: 37–42. 4. Бураковский В.И., Бокерия Л.А. (ред.) Сердечно-сосудистая хирургия: Руководство. М.: Медицина; 1996. 5. Сокольская Н.О., Алшибая М.М. и др. Динамика эхокардиографических показателей в раннем послеоперационном периоде у больных после выполнения реконструктивных операций на левом желудочке и коронарного шунтирования. Анестезиология и реаниматология. 2006; 3: 64–7. 6. Шиллер Н., Осипов И.А. Клиническая эхокардиография. М.: Мир; 1993. 7. Sokolskaya N.O., Malashenkov A.I., Rusanov N.I., Rychin S.V., Kopylova N.S. Geometric and functional characteristics of the left ventricle in patients with aneurysm and dissecting aneurysm of the ascending aorta before surgery and in the early postoperative period. Interactive CardioVascular and Thoracic Surgery. 60th ESCVS International Congress. Moscow; 2011: 166. 8. Walker D., West N., Ray S. et al. From coronary care unit to acute cardiac care unit – the evolving role of specialist cardiac care. Recommendations of the British cardiovascular society working group on acute cardiac care. 2011: 1–35. 9. Haji D.L., Royse A., Royse C.F. Clinical impact of non-cardiologist-performed transthoracic echocardiography in emergency medicine, intensive care medicine and anaesthesia. Emergency Medicine Australasia. 2013; 25: 4–12. 10. Бураковский В.И., Бокерия Л.А., Цховребов С.В. и др. Компьютерная технология интенсивного лечения: контроль, анализ, диагностика, лечение, обучение. М.: НЦССХ им. А.Н. Бакулева РАМН; 1995. 11. Зубкова Г.А. Эхокардиография при митральных пороках сердца у больных на дооперационном периоде и после различных типов оперативного вмешательства: Дис. … канд. мед. наук. М.; 1979. 12. Капба И.В. Функция сердца в послеоперационном периоде у детей раннего возраста с ВПС (по данным эхокардиографии): Дис. … канд. мед. наук. М.; 1989. 13. Митина И.Н. Эхокардиографическая диагностика врожденных пороков сердца, сопровождающихся патологией атриовентрикулярных клапанов: Дис. … канд. мед. наук. М.; 1982. 14. Митьков В.В., Сандриков В.А. Клиническое руководство по ультразвуковой диагностике. М.: Видар; 1998; V. 15. Поплавская Л.М. Диагностика и лечение нарушений ритма сердца и проводимости в раннем послеоперационном периоде у больных после протезирования клапанов сердца: Дис. … д-ра мед. наук. М.; 1996. 16. Соболева Н.Н. Неинвазивная гемодинамическая оценка функции протеза ЭМИКС в аортальной позиции: Дис. … канд. мед. наук. М.; 2001. 17. Ferrada P., Murthi S., Anand R. et al. Transthoracic focused rapid echocardiographic examination: real-time evaluation of fluid status in critically ill trauma patients. Journal of Trauma-injury Inferction and Critical Care. 2011; 70 (1): 56–64. 18. Gottdiener J., Bednarz J., Devereux R. et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J. Am. Soc. Echocardiogr. 2004; 17: 1086–119. 19. Chambers J. Accreditation in echocardiography. SA Heart Autumn. 2010; 7: 90–2. 20. Herbst P. Echocardiography: is there unseen risk in cardiac ultrasound? SA Heart Autumn. 2010; 7 (8): 86–9. 21. Lang R., Bierig M., Devereux R. et al. Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology. J. Am. Soc. Echoсardiogr. 2005; 18: 1440–63. 22. Samad B., Alam M., Jensen-Urstad K. Prognostic impact of right ventricular involvement as assessed by tricuspid annular motion in patients with acute myocardial infarction. Am. J. Cardiol. 2002; 90: 778–81. 23. Бокерия Л.А., Салагай О.О., Самородская И.В., Сокольская Н.О., Сон И.М., Волкова И.И., Крупянко С.М. Стандарты медицинской помощи в соблюдении баланса качества и стоимости в сердечно-сосудистой хирургии: правовой и организационный аспекты. Грудная и сердечно-сосудистая хирургия. 2012; 4: 4–8.

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