Focused echocardiography: a systematic review of diagnostic and clinical decision-making in anaesthesia and critical care

Heiberg, J. et al. (2016). Anaesthesia. Volume 71(9). pp. 1091–1100

524px-transesophageal_echocardiography_diagram-svg

Image source: Patrick J. Lynch, medical illustrator – Wikipedia // CC BY 2.5

Image shows illustration of transesophageal echocardiography ultrasound diagram

Focused echocardiography is becoming a widely used tool to aid clinical assessment by anaesthetists and critical care physicians. At the present time, most physicians are not yet trained in focused echocardiography or believe that it may result in adverse outcomes by delaying, or otherwise interfering with, time-critical patient management.

We performed a systematic review of electronic databases on the topic of focused echocardiography in anaesthesia and critical care. We found 18 full text articles, which consistently reported that focused echocardiography may be used to identify or exclude previously unrecognised or suspected cardiac abnormalities, resulting in frequent important changes to patient management. However, most of the articles were observational studies with inherent design flaws. Thirteen prospective studies, including two that measured patient outcome, were supportive of focused echocardiography, whereas five retrospective cohort studies, including three outcome studies, did not support focused echocardiography. There is an urgent requirement for randomised controlled trials.

Read the full article here

Disagreement between cardiac output measurement devices: which device is the gold standard?

Y. Le Manach & G. S. Collins. British Journal of Anaesthesia (2016) 116 (4):451-453.

A common research question in perioperative haemodynamics research concerns the assessment of whether a new measurement device can replace an existing device (often referred to as method comparison studies). Typically, a new measurement method is being compared with an established reference method (unfortunately often referred to as the ‘gold standard’).

In a recent issue of the journal, Biais and colleagues reported the comparison of two cardiac output measurement devices, one based on pulse wave transit time (i.e. the new devices) and the other one based on transthoracic echocardiography (i.e. the reference method ‘gold standard’). The study concluded that devices were not interchangeable and that the new device cannot guide haemodynamic interventions in critically ill patients. Their conclusion was based on observing percentage errors exceeding the limits of 30%, suggested by Critchley and Critchley.

Read the abstract here