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Point-of-care ultrasonography is conceptually related to physical examination.
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The intensivist uses visual assessment, auscultation, and palpation on an ongoing basis to monitor their patient.
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Ultrasonography adds to traditional physical examination by allowing the intensivist to visualize the anatomy and function of the body in real time.
Bedside Ultrasonography for the Intensivist
Section snippets
Key points
Videos of a normal parasternal long-axis view, a normal parasternal short-axis view, a normal apical 4-chamber view, a normal subcostal long-axis view, an
The components of critical care ultrasonography
The American College of Chest Physicians/La Société de Réanimation de Langue Française Statement on Competence in Critical Care Ultrasonography (ACCP/SRLF Statement) is a guide for the intensivist in setting goals of training.1 The statement defines 5 modules of CCUS:
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Cardiac: basic and advanced levels
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Thoracic: lung and pleura
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Vascular access
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Vascular diagnostic: examination for deep venous thrombosis (DVT)
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Abdominal: screening examination
Another consensus statement that was sponsored by the major
Equipment requirements for critical care ultrasonography
In general, modern portable ultrasonography machines have good image quality. The standard ICU machine is equipped with both a high-frequency (5.0–10 MHz) linear probe for vascular imaging and a low-frequency (1.0–5.0 MHz) phased-array probe for cardiac and thoracic imaging. Some machines are designed so that the cardiac probe can be configured for abdominal imaging so that it is a dual-purpose device, thus avoiding the need to purchase a third probe designed for abdominal scanning. In deciding
Levels of Competence
The ACCP/SRLF Statement distinguishes between basic and advanced level critical care echocardiography (CCE).1 Basic CCE uses a limited number of transthoracic echocardiography (TTE) views. Mastery of basic CCE is a key skill for all frontline critical care clinicians, and can be learned within a relatively short training period. Competence in advanced CCE requires a skill level comparable to a cardiology-trained echocardiographer in both TTE and transesophageal echocardiography (TEE), and
Thoracic: pleura and lung
Ultrasonographic examination of the lung and pleura is easy to learn and has wide application for the intensivist. Thoracic ultrasonography is superior to standard chest radiography in the ICU, where the supine, rotated, anterior-posterior chest film of variable penetration frequently yields a nonspecific radio-opacity pattern. When compared with computed tomography (CT) of the chest, thoracic ultrasonography is similar in performance for identifying pneumothorax, normal aeration pattern,
Central Venous Access
The use of ultrasonography to guide central venous access results in increased success and reduced complication rates for access to the internal jugular vein (IJV), subclavian vein (SCV), and common femoral vein (FV). For this reason, it is mandated by the Agency for Healthcare Research and Quality,42 and is part of routine ICU function. It requires the use of a linear vascular probe (5.0–10.0 MHz) and a purpose-designed sterile probe cover. Real-time imaging of needle insertion is superior to
Summary
CCUS is a useful skill for the intensivist. Competence in CCUS requires mastery of basic CCE, thoracic, vascular access, vascular diagnostic, and abdominal screening ultrasonography.
References (48)
- et al.
American College of Chest Physicians/Société de Réanimation de Langue Française statement on competence in critical care ultrasonography
Chest
(2009) - et al.
Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians
J Am Soc Echocardiogr
(2010) - et al.
Shock: ultrasound to guide diagnosis and therapy
Chest
(2012) - et al.
The use of computerised simulators for training of transthoracic and transesophageal echocardiography. The future of echocardiography training?
Heart Lung Circ
(2012) - et al.
Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients
J Cardiothorac Vasc Anesth
(2005) - et al.
Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms
Chest
(2013) - et al.
Goal-directed transesophageal echocardiography performed by intensivists to assess left ventricular function: comparison with pulmonary artery catheterization
J Cardiothorac Vasc Anesth
(1998) - et al.
Advanced echocardiography for the critical care physician: part 1
Chest
(2014) - et al.
Advanced echocardiography for the critical care physician: part 2
Chest
(2014) - et al.
Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED?
Chest
(2011)
Safety of ultrasound-guided thoracentesis in patients receiving mechanical ventilation
Chest
A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding
Chest
The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis
Chest
Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol
Chest
Pleural ultrasound compared with chest radiographic detection of pneumothorax resolution after drainage
Chest
A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill
Chest
Ultrasound-guided catheterization of the radial artery: a systematic review and meta-analysis of randomized controlled trials
Chest
Accuracy of ultrasonography performed by critical care physicians for the diagnosis of deep venous thrombosis Koenig
Chest
Making paracentesis safer: a proposal for the use of bedside abdominal and vascular ultrasonography to prevent a fatal complication
Chest
International expert statement on training standards for critical care ultrasonography
Intensive Care Med
International consensus statement on training standards for advanced critical care echocardiography
Intensive Care Med
Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients
Intensive Care Med
The respiratory variation in the inferior vena cava diameter as a guide to fluid therapy
Intensive Care Med
Cited by (16)
Application of Focused Assessment with Sonography for Trauma in the Intensive Care Unit
2022, Clinics in Chest MedicineCitation Excerpt :The American College of Surgeons lists it in the “Best Practice in Imaging Guidelines,” and the American College of Emergency Physicians lists it as a “core” ultrasound skill for emergency physicians. Its use is described in numerous critical care publications.1,25–27 Although its traditional application is the evaluation of patients with trauma for immediately intervenable injuries, its ability to rapidly identify intraperitoneal fluid, hemothorax, pneumothorax, and pericardial effusion can provide the intensivist with invaluable information to guide patient management.
Maternal Sepsis and Septic Shock
2016, Critical Care ClinicsCitation Excerpt :A variety of noninvasive techniques are now emerging to assess hemodynamic variables in the unstable patient.29,31–34,39,86 Bedside ultrasound may be useful to guide fluid management, with assessment of inferior vena cava (IVC) size and collapse to various maneuvers, to estimate status of vascular volume and fluid responsiveness.87 However, use of IVC changes to guide fluid resuscitation in pregnant patients has not been well studied, and positional effects as well as correlations with vascular volume may differ from the nonpregnant state.36
Ultrasound Training in Surgical Critical Care Fellowship: A Survey of Program Directors
2018, Journal of Surgical EducationCitation Excerpt :In recognition of the important role of CCUS in modern ICU care, the Society of Critical Care Medicine (SCCM) and American College of Chest Physicians (ACCP) both called for mandatory CCUS education during fellowship.8 Similarly, the Accreditation Council for Graduate Medical Education has required that US be part of critical care fellowship training.1,9 An international position statement on CCUS training has been published,8 as have statements from the ACCP and SCCM regarding the minimum standards for competence.10,11
Point-of-care ultrasound for acute abdomen: 5W1H (Translated version)
2022, Journal of Medical Ultrasonics