Elsevier

Critical Care Clinics

Volume 31, Issue 1, January 2015, Pages 43-66
Critical Care Clinics

Bedside Ultrasonography for the Intensivist

https://doi.org/10.1016/j.ccc.2014.08.003Get rights and content

Section snippets

Key points

  • Point-of-care ultrasonography is conceptually related to physical examination.

  • The intensivist uses visual assessment, auscultation, and palpation on an ongoing basis to monitor their patient.

  • Ultrasonography adds to traditional physical examination by allowing the intensivist to visualize the anatomy and function of the body in real time.

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:

  • Cardiac: basic and advanced levels

  • Thoracic: lung and pleura

  • Vascular access

  • Vascular diagnostic: examination for deep venous thrombosis (DVT)

  • 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.

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References (48)

  • P.H. Mayo et al.

    Safety of ultrasound-guided thoracentesis in patients receiving mechanical ventilation

    Chest

    (2004)
  • D.A. Lichtenstein et al.

    A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding

    Chest

    (1995)
  • D. Lichtenstein et al.

    The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis

    Chest

    (2009)
  • D.A. Lichtenstein et al.

    Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol

    Chest

    (2008)
  • A. Galbois et al.

    Pleural ultrasound compared with chest radiographic detection of pneumothorax resolution after drainage

    Chest

    (2010)
  • D.A. Lichtenstein et al.

    A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill

    Chest

    (2009)
  • A.L. Shiloh et al.

    Ultrasound-guided catheterization of the radial artery: a systematic review and meta-analysis of randomized controlled trials

    Chest

    (2011)
  • P.D. Kory et al.

    Accuracy of ultrasonography performed by critical care physicians for the diagnosis of deep venous thrombosis Koenig

    Chest

    (2011)
  • H. Sekiguchi et al.

    Making paracentesis safer: a proposal for the use of bedside abdominal and vascular ultrasonography to prevent a fatal complication

    Chest

    (2013)
  • B.P. Cholley et al.

    International expert statement on training standards for critical care ultrasonography

    Intensive Care Med

    (2011)
  • Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in...
  • A. Vieillard-Baron et al.

    International consensus statement on training standards for advanced critical care echocardiography

    Intensive Care Med

    (2014)
  • C. Barbier

    Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients

    Intensive Care Med

    (2004)
  • M. Feissel

    The respiratory variation in the inferior vena cava diameter as a guide to fluid therapy

    Intensive Care Med

    (2004)
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