• Sarah B Murthi, Manjunath Markandaya, Raymond Fang, Caron M Hong, Samuel M Galvagno, Mattew Lissuaer, Lynn G Stansbury, and Thomas M Scalea.
• Department of Surgery, Division of Trauma and Surgical Critical Care, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201.
• Mil Med. 2015 Mar 1; 180 (3 Suppl): 74-9.

ObjectivesTo determine whether comprehensive quantitative echocardiogram could be used as a resuscitation tool in critically ill surgical patients and to assess its effect on patient care.DesignProspective observational.SettingThe Trauma and Surgical Intensive Care Units of the University of Maryland Medical Center.PatientsCritically ill trauma and surgical patients.InterventionsThe Focused Rapid Echocardiographic Evaluation (FREE), an abbreviated version of a comprehensive transthoracic echocardiogram, which is under an approved protocol, was performed.Measurements And Main ResultsOver a 30-month period, 791 FREEs were performed on 659 patients. The mean patient age was 60 (±17) years. Ninety-one percent were intubated and 80% were postoperative. Ejection fraction was reported for 95%, and cardiac index was reported for 89% of FREE studies. Right heart function was assessed for 94%. Measures of volume status--internal left ventricular diameter, inferior vena cava diameter, diameter change, and stroke volume variation--were reported for 88%, 79%, 75%, and 89% of patients, respectively. The FREE was judged to be useful by the consulting primary care team for 95% of patients, and altered the plan of care for 57%. The most common change was administration of a fluid bolus (43%), followed by change from an original prestudy plan to one of monitoring (24%), diuresis (23%), addition/titration of an inotropic agent (19%), and/or addition/titration of a vasoconstrictor (8%).ConclusionsThe FREE is feasible and alters care in the intensive care unit by providing clinical data not otherwise available at the bedside. Further studies are warranted to assess the impact of comprehensive echocardiogram-directed resuscitation on patient outcomes.Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

25 keywords...

hide…