Vol.2, No.3, 189-193 (2013) Case Reports in Clinical Medicine http://dx.doi.org/10.4236/crcm.2013.23052 Focus assessed transthoracic echocardiography (FATE) to diagnose pleural effusions causing haemodynamic compromise Nils Petter Oveland 1,2* , Nigussie Bogale 3 , Benedict Waldron 4 , Kasper Bech 4 , Erik Sloth 4,5 1 Department of Research and Development, Norwegian Air Ambulance Foundation, Droebak, Norway; * Corresponding Author: nils.petter.oveland@norskluftambulanse.no 2 Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway 3 Department of Cardiology, Stavanger University Hospital, Stavanger, Norway 4 Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark 5 Faculty of Health Sciences, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark Received 24 March 2013; revised 25 April 2013; accepted 15 May 2013 Copyright © 2013 Nils Petter Oveland et al. This is an open access article distributed under the Creative Commons Attribution Li- cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT The clinical assessment of patients with respi- ratory and circulatory problems can be complex, time consuming and have a high incidence of error. Bedside transthoracic ultrasound (US) is a useful adjunctive test in the evaluation of acu- tely unstable patients. This case series descri- bes the use of the Focus Assessed Transtho- racic Echocardiography (FATE) protocol to di- agnose unsuspected pleural collections of fluid and how drainage significantly contributes to the haemodynamic improvement seen in these patients. Keywords: Pleural Effusions; Haemodynamic Instability; Haemothorax; Transthoracic Echocardiography 1. INTRODUCTION The physical examination is the basis for treatment- decisions of hospitalized critical ill patients often supp- lemented with measurements of hearth rate, respiratory rate, pulse oxymetry and arterial blood pressure. De- pending on the clinical scenario, additional diagnostic tests and procedures such as 12-lead electrocardiogram (ECG), chest X-ray (CXR), arterial blood gas analysis, central venous catheter and pulmonary artery catheter insertions are applied. The resuscitative actions from the treating physicians are commonly intravascular fluid adjustments and/or pharmacological inotropic support [1]. This approach is successful in the majority of cases as many haemodynamic unstable patients benefit from in- creased preload and have some reserve myocardial con- tractility, which can be improved by inotropic agents. However, this primary survey may lack sufficient diag- nostic finesse is subgroups of patients, resulting in mis- diagnosis and poorly directed therapy. Pleural effusions are an under-recorded contributor to haemodynamic instability in intensive care units (ICUs). Experimental physiological models (i.e., using animals) have shown that bilateral pleural effusions produce right ventricular end diastolic collapse and changes in cardiac output that mimic a large pericardial effusion [2]. Fur- thermore, pleural collections can increase the negative circulatory effect of even small pericardial effusions [3]. Several studies have reported improved haemodynamic parameters following drainage of these pleural effusions with ranging volumes between 500 mL and 2000 mL [4-8]. Traditionally anteroposterior CXR has been used to detect pleural fluid collections. This method is time- consuming and less sensitive when the picture is taken in the supine position [9], whereas ultrasound (US) imaging techniques can reliably detect pleural effusions as small as 100 mL in the supine position (Figure 1) [10]. In the past two decades there has been an increasing use of point-of-care US (i.e., scanning performed by the treat- ing physicians at bedside). The Focus Assessed Tran- sthoracic Echogardiography (FATE) protocol [10], the Focused Assessment with Sonography for Trauma (FAST) protocol [11], the extended FAST protocol [12], the Undifferentiated Hypotensive Patient (UHP) protocol [13], the Abdominal and Cardiac Evaluation with Sono- graphy in shock (ACES) [14] and the Focused Echocar- diographic Evaluation in Resuscitation (FEER) [15] are Copyright © 2013 SciRes. OPEN ACCESS