Use of echocardiography for hemodynamic monitoring.

Objective: To assess the accuracy of echocardiography for hemodynamic monitoring.

Data Sources: A computerized MEDLINE search was used with the following search headings: monitoring (physiologic and intra-operative) and both echocardiography and transesophageal echocardiography. A number of studies were obtained from the reference lists of cardiology reviews and textbooks.

Study Selection: Studies that were designed to assess the accuracy of hemodynamic monitoring.

Data Extraction: From the selected studies, the accuracy of different techniques for measuring preload and cardiac output was compared.

Data Synthesis: Hypovolemia can be detected accurately by measuring left ventricular end-diastolic area. At high preload, Doppler-based methods are more accurate, although further studies in critical care patients are needed. Cardiac output is best measured by measuring Doppler flow, preferably across the aortic valve.

Conclusions: Echocardiography can be used to make accurate hemodynamic measurements; however, training is required. Further studies are needed to validate these methods in the management of critically ill patients.