The problem this book addresses
Three literatures collide at the bedside of a shocked, ventilated patient, and none of them was written for that bedside.
The cardiology imaging literature supplies the thresholds. It validated them in ambulatory patients in sinus rhythm, breathing spontaneously at rest, at a heart rate of 70/min, off inotropes. The 2025 ASE diastolic guideline states plainly that its algorithm is not to be applied intraoperatively; it says nothing about the ventilated septic patient because that patient was never in the validation cohort.
The point-of-care ultrasound literature supplies the accessibility. It is deliberately binary — effusion or no effusion, "squeeze" or "no squeeze" — and it is excellent at what it claims to do. It becomes dangerous when a binary tool is used to answer a quantitative question.
The intensive care physiology literature supplies the reasoning: ventriculo-arterial coupling, heart–lung interaction, the difference between fluid responsiveness and fluid need. It is largely absent from imaging teaching.
Advanced critical care echocardiography is the discipline that holds all three simultaneously. This book is an attempt to write it down.
What this book is
- Complete. The intention is coverage of every topic where echocardiography changes a decision in critical illness — from knobology to ECMO cannula positioning to obstetric collapse.
- Referenced to the primary document. No threshold appears without a source. Where a number is expert opinion, it says so.
- Explicit about failure modes. Every parameter chapter states what mechanical ventilation, arrhythmia, vasopressors, and RV overload do to that measurement.
- Versioned and open. Guidelines change. The book is a repository, not a printed object; chapters carry the guideline generation they were written against.
What this book is not
It is not a substitute for supervised scanning. Image acquisition is a motor skill; no text transfers it. It is not a credentialling pathway. It is not medical advice.
Provenance and honesty
Content that derives from a specific guideline is attributed to that guideline. Content that reflects physiological reasoning without direct trial evidence is labelled as such. Where an area is genuinely contested — the prognostic meaning of septic cardiomyopathy, the utility of the IVC in ventilated patients, the correct threshold for acute cor pulmonale — the disagreement is presented rather than resolved by editorial fiat.
Two guideline documents were superseded during the writing of this edition. The ASE prosthetic valve guideline was replaced by the 2024 version (JASE 2024;37:2–63) partway through drafting, and the ASE diastolic and right heart guidelines were both replaced by their 2025 editions. Each chapter therefore carries a Guideline basis callout naming the exact documents it rests on, so that the next revision is a matter of checking a list rather than re-reading the book.
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