ICU · Monitoring / echocardiography
Critical-Care Echocardiography — FOCUS & FATE
Also known as Focused cardiac ultrasound · FOCUS · Focused assessment with transthoracic echocardiography · FATE · Bedside echo · Point-of-care echocardiography · IVC assessment · Parasternal long axis · PLAX · Apical 4-chamber
Focused cardiac ultrasound (FOCUS or FATE) is the bedside, clinician-performed transthoracic echocardiogram for the critically ill patient, designed to answer specific resuscitation questions in real time — not a comprehensive echo. The five standard views (parasternal long axis, parasternal short axis, apical 4-chamber, subcostal, and the IVC) answer: is the LV hyperdynamic (hypovolaemia) or hypokinetic (cardiogenic)? Is the RV dilated (PE, cor pulmonale)? Is there a pericardial effusion (tamponade)? Is the IVC collapsing (volume-responsive) or plethoric (high right-sided pressures)? Gross valve abnormalities? FOCUS complements — it does not replace — the formal comprehensive echo.
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A 72-year-old man is admitted to ICU with confusion and hypotension of unclear cause — BP 76/48, HR 128, SpO2 93 per cent on 15 L, lactate 5.2, temperature 38.9, urine 10 mL an hour. His peripheries are warm but his JVP is markedly raised. A phased-array probe and a portable machine are at the bedside, and the consultant asks you to perform a focused cardiac ultrasound to categorise the shock.[1]
The point of FOCUS here is not to quantify an ejection fraction — it is to sort the shock in five minutes: tamponade (effusion with chamber collapse), obstructive (a dilated RV with a D-shaped septum — PE), cardiogenic (a dilated hypokinetic LV), hypovolaemic (a small hyperdynamic kissing LV), or distributive (a normal-looking heart). One sweep through five views answers that, and the answer changes the next drug you reach for.[1]
References10ShowHide
- [1]Nagre AS. Focus-assessed transthoracic echocardiography: Implications in perioperative and intensive care Ann Card Anaesth, 2019.PMID 31274494
- [2]Mayo PH, Beaulieu Y, Doelken P, et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography Chest, 2009.PMID 19188546
- [3]Via G, Hussain A, Wells M, et al. International evidence-based recommendations for focused cardiac ultrasound J Am Soc Echocardiogr, 2014.PMID 24951446
- [4]Monnet X, Marik PE, Teboul JL Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis Intensive Care Med, 2016.PMID 26825952
- [5]Lamia B, Ochagavia A, Monnet X, et al. Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity Intensive Care Med, 2007.PMID 17508199
- [6]Vieillard-Baron A, Page B, Augarde R, et al. Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic pattern, clinical implications and recovery rate Intensive Care Med, 2001.PMID 11685341
- [7]McConnell MV, Solomon SD, Rayan ME, et al. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism Am J Cardiol, 1996.PMID 8752195
- [8]Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism N Engl J Med, 2002.PMID 12374874
- [9]Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound Intensive Care Med, 2012.PMID 22392031
- [10]Barbier C, Loubières Y, Schmit C, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients Intensive Care Med, 2004.PMID 15034650