Summary: Diagnosis and subsequent appropriate support of the cardiovascular system in critically injured and critically ill surgical patients is the foundation of management in these very complex patients. The clinician’s ability to provide adequate and appropriate therapy depends upon the understanding of three fundamental principles: 1) the definitions of global cardiovascular performance and tissue perfusion, 2) a working knowledge of the independent determinants of cardiovascular function and how they affect global cardiac function, and 3) a basic understanding of how the heart interacts with the pulmonary and systemic vascular systems, referred to as Ventricular-Vascular Coupling. Understanding and applying these principles is of paramount importance if the clinician expects to have the patient achieve optimal perfusion in the shortest possible time while minimizing complications...

Independent Determinants of Cardiovascular Function
If global cardiovascular function is found to be inadequate, the next diagnostic step should involve determining which one or more of the independent determinants of cardiovascular function (heart rate, preload, afterload, or myocardial contractility) are deranged...

Once vasoactive/inotropic agents are begun, measurements of LVEDA and FAC are repeated to assess efficacy, and further titration is continued until cardiovascular performance is optimized. Of note, complex critically ill and injured patients will be quite dynamic from the standpoint of preload, contractility and afterload. For this reason, ongoing assessment with frequent interventions including fluid administration and medication titration will be required and is supported by the ImaCor hTEE probe.

Summary: We have seen an increase in interest in weaning or reducing pressors among hTEE users; in particular, Dr. Jiri Horak from the Hospital of the University of Pennsylvania continues to regularly use hTEE for this purpose. Dr. Horak and Dr. Amy Reed (now at Beth Deaconess Medical Center, Boston) presented two recent cases at the 2012 SCCM meeting in Houston. This interest led me to take another look and review how physicians have used hTEE to wean or reduce pressors – here are some representative cases presented at meetings or published by hTEE users, together with two studies presented at meetings by hTEE users.

Summary: We are pleased to introduce our new Zura version 2.1.5, now available to all existing and prospective customers.

The Zura offers the following new features designed to make image acquisition even easier, cleaner and faster to obtain:

--A new Initialization Screen demonstrating hTEE views and tutorials to remind busy clinicians of the three-view hTEE exam during system start-up;

--Access to the three-view hTEE exam directly from the Imaging Screen to reinforce ImaCor training of new users;

--Enhanced Auto-Q, the gain control feature which automatically adjusts levels for optimal image clarity in less than one second;

--Cineloop Image Quality Settings stores & recalls any adjustments made to cineloop image quality during playback;

--Simplified steering of the ultrasound with console keys ‘<’ '>' to steer left and right rather than move the probe indwelling;

Summary: Over the past three years, ImaCor has had the wonderful opportunity to partner with some of the best clinicians at some of the best hospitals in the world. These enduring partnerships have led to the publication of clinical abstracts, case reports, and journal articles about the direct impact ImaCor's miniaturized ClariTEE™ probe has had on the care of their patients. In total, we have amassed 48 clinical publications and have approximately 10 multicenter studies at various stages of development taking place around the world.