Transthoracic Echo Helps Determine Fluid and Cardiac Status in Trauma Patients

This noninvasive procedure is readily available.


The Focused Assessment with Sonography for Trauma (FAST) has become a valuable study for determining presence of intra-abdominal hemorrhage and need for surgical intervention in trauma patients. These authors evaluated the clinical value of transthoracic Focused Rapid Echocardiographic Examination (FREE) for assessing fluid volume and cardiac function in trauma patients. The FREE consists of three views: parasternal, to visualize mitral and aortic valves and left ventricular (LV) function; apical, to assess right ventricular and LV function; and subxiphoid, to assess pericardial effusion and inferior vena cava (IVC) diameter and collapsibility in M-mode.

During 9 months at a single level I trauma center, 53 patients (mean age, 62; 62% men) underwent FREE by critical care and trauma fellows (32%) or cardiac technicians (68%) in the trauma intensive care unit (ICU). Estimated ejection fraction was obtained in 80% of patients, moderate and severe LV dysfunction was diagnosed in 56%, right heart dysfunction was diagnosed in 25%, and IVC diameter and IVC respiratory variation were visualized in 87%. Clinicians who ordered the examinations reported that they were useful for determining volume status, cardiac function, and type of shock and that the results led to changes in therapy in 54% of patients.


Citation(s):

Ferrada P et al. Transthoracic focused rapid echocardiographic examination: Real-time evaluation of fluid status in critically ill trauma patients. J Trauma 2011 Jan; 70:56.