Côrte-Real Hugo, França Carlos
Serviço de Medicina Intensiva, Hospital de Santa Maria/Faculdade de Medicina de Lisboa, Lisboa, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 4:747-54. Epub 2011 Dec 31.
The use of the transoesophageal echocardiography (TEE) in the critically ill patient admitted to the general intensive care unit begins to turn out to be very important but it is still little spread. The full implementation of the echocardiography in the general intensive cares is compromised by the acoustic window. However, TEE can flyover this difficulty adding to the advantages widely described of the transthoracic echocardiography (TTE) other high values 1. The TEE manages to do the dynamic evaluation of the necessity of fluids, able to discriminate fluid responders, able to distinguish types of shock, assess systolic and diastolic function of both ventricles, able to evaluate other structures of the heart and be a guide to therapy. The use of the echocardiography in the ventilated patient admitted to the general intensive care unit still lack for some definition. This clinical commentary was carried out by the intention of revising the most relevant literature that values the use and efficiency of the TEE in the ventilated critically ill patient in order to explain its use and consequently helping to implement the TEE in clinical practice. So, one managed to define the application of the TEE in the critically ill patient in several clinical scenarios, the haemodynamically unstable patient, the patient with global respiratory insufficiency, the patient with hipoxémia.
在入住综合重症监护病房的危重症患者中,经食管超声心动图(TEE)的应用已开始显得非常重要,但目前其普及程度仍然较低。由于声窗的问题,超声心动图在综合重症监护中的全面应用受到了限制。然而,TEE能够克服这一困难,除了经胸超声心动图(TTE)已被广泛描述的优点外,还具有其他重要价值。TEE能够对液体需求进行动态评估,能够鉴别液体反应者,能够区分休克类型,评估双心室的收缩和舒张功能,能够评估心脏的其他结构,并为治疗提供指导。在入住综合重症监护病房的机械通气患者中,超声心动图的应用仍缺乏明确的定义。本临床评论旨在回顾最相关的文献,这些文献评估了TEE在机械通气危重症患者中的应用和有效性,以解释其用途,并因此有助于在临床实践中应用TEE。因此,人们设法确定了TEE在几种临床情况下在危重症患者中的应用,即血流动力学不稳定的患者、全球呼吸功能不全的患者、低氧血症患者。