Dezembro de 2009 - Vol 16 numero 3 - Sociedade Portuguesa de ...

Rev Port Med Int 2009; Vol 16(3)
considered a standard echocardiographic
examination 20,21,22 . As a result, a complete and
comprehensive study such as a formal TTE or
TOE should be always asked immediately after
the goal-directed examination (GDE) when any
doubt emerges to the NCPI. Beauleau (2007)
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mentioned that even on mechanically
ventilated patient TTE allow adequate
evaluation of global LV function in 77%. FTES
always involve, only limited by patient habitus,
dressings, wounds and patient’s morbidities,
the use of three echocardiographic windows
views, parasternal short-axis (PSax), apical
four chamber views (AP4) and subxiphoid
(Sxp), in that order, only on two-dimensional
mode. (Fig. 1) (Fig. 2) (Fig. 3).
Fig. 1- parasternal short-axis (PSax)
Fig. 2-apical four chamber views (AP4)
Fig. 3- subxiphoid (Sxp)
The aim is to answer five simple questions,
in order to define an hemodynamic profile and
consequently be able to optimize their
treatments: how is the VS, how are the LV and
RV functions, how are the chambers, how is
the pericardium (cardiac tamponate) and are
there any other gross abnormalities (mobile
mass on valves or in chambers). All the FTES’
imaging positions, PSax, AP4 and Sxp
echocardiographic views, should be always
and systematically performed because of the
possibility of further disorders, which would
otherwise be missed. In addition, a specific
finding may be better evaluated from a
combination of different views. In order to
persist a strategy simple to performed, FTES
should be done in a qualitatively manner. It is
possible to teach NCPI to use FTES as an
extension of the physical examination, creating
a tremendous advantage for bedside
assessement and treatment of the critically ill
patient admitted to a (GICU). Many good
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