Bedside Ultrasonography in the ICU

Beaulieu, Yanick; Marik, Paul E.

doi:10.1378/chest.128.3.1766

Cited by 144 publications

(77 citation statements)

References 137 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, the diaphragm is inaccessible to direct clinical assessment. Bedside ultrasonography, which is already crucial in several aspects of critically illness, 81,82 has recently been proposed as a simple, noninvasive method of quantification of diaphragm contractile activity. 4 Ultrasound can be used to determine diaphragm excursion, 83,84 which may help to identify patients with diaphragm dysfunction.…”

Section: Bedside Ultrasonography In Critically Ill Patientsmentioning

confidence: 99%

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

View full text Add to dashboard Cite

The majority of patients admitted to the ICU require mechanical ventilation as a part of their process of care. However, mechanical ventilation itself or the underlying disease can lead to dysfunction of the diaphragm, a condition that may contribute to the failure of weaning from mechanical ventilation. However, extended time on the ventilator increases health-care costs and greatly increases patient morbidity and mortality. Nevertheless, symptoms and signs of muscle disease in a bedridden (or bed rest-only) ICU patient are often difficult to assess because of concomitant confounding factors. Conventional assessment of diaphragm function lacks specific, noninvasive, time-saving, and easily performed bedside tools or requires patient cooperation. Recently, the use of ultrasound has raised great interest as a simple, noninvasive method of quantification of diaphragm contractile activity. In this review, we discuss the physiology and the relevant pathophysiology of diaphragm function, and we summarize the recent findings concerning the evaluation of its (dys)function in critically ill patients, with a special focus on the role of ultrasounds. We describe how to assess diaphragm excursion and diaphragm thickening during breathing and the meaning of these measurements under spontaneous or mechanical ventilation as well as the reference values in health and disease. The spread of ultrasonographic assessment of diaphragm function may possibly result in timely identification of patients with diaphragm dysfunction and to a potential improvement in the assessment of recovery from diaphragm weakness.

show abstract

Section: Bedside Ultrasonography In Critically Ill Patientsmentioning

confidence: 99%

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Umbrello

Formenti

2016

Respir Care

View full text Add to dashboard Cite

show abstract

“…In addition, we confirmed that where there are physical limitations for signal acquisition related to body habitus as in MO, detailed comprehensive assessment of filling pressures can be difficult and time-consuming. We chose to evaluate volume-responsiveness by measuring TTE-derived ΔSV by LVOTmethod in VC because of high reproducibility and feasibility (28). Theoretically passive leg raising manoeuvre (PLR) is an alternative for bringing about a change in venous return (29,30).…”

Section: Discussionmentioning

confidence: 99%

Morbid Obesity and Optimization of Preoperative Fluid Therapy

et al. 2013

View full text Add to dashboard Cite

Morbid obesity and optimization of preoperative fluid therapy. AbstractContext: Preoperative venous return (VR) optimization and adequate blood volume is essential in management of morbidly obese patients (MO) in order to avoid perioperative circulatory instability. In this study, all subjects underwent a preoperative three-week preparation by rapid-weight-loss-diet (RWL) as part of their treatment program for bariatric surgery. Design: Prospective, observational study. Setting: Sunderby County Hospital, Luleå, Sweden. Subjects: Thirty-four morbidly obese patients consecutively scheduled for bariatric surgery. Interventions: Preoperative transthoracic echocardiography (TTE) was performed in the awake state before and after intravascular volume-challenge (VC) of 6 ml colloids/kg ideal body weight (IBW). Effects of standardized VC were evaluated by TTE. Dynamic and nondynamic echocardiographic indices for VC were studied. Main outcome measures: Volume-responsiveness and level of VR before and after VC were assessed by TTE. An increase of stroke volume (Δ SV) ≥ 13% was considered as a volumeresponder. Results: 29/34 patients were volume-responders. After VC, a majority of patients (23/34) were euvolemic, and only 2/34 were hypovolemic. Post VC hypervolemia was observed in 9/34 of patients. Conclusions: The IBW-based volume challenge regimen was found to be suitable for preoperative rehydration of RWL-prepared MO. Most of the patients were volumeresponders. Preoperative state of VR was not associated with volume-responsiveness. IBWestimates and appropriate monitoring avoids potential hyperhydration in MO. For VC assessment, conventional Doppler indices were found to be more suitable compared to tissue Doppler, giving sufficient information on pressure-volume correlation of the left ventricle in morbidly obese.

show abstract

“…Other elements that can limit imaging acquisition are related to surgical injury and chest dressings that can alter or preclude the transmission of ultrasound beams to the lung, with obesity and COPD also potentially worsening the quality of the images [7] . Absence of patient compliance and difficulty in moving patients into the ideal position makes several studies technically inadequate [65] . Finally, there are the disease limitations.…”

Section: Limitations Of the Techniquementioning

confidence: 99%

Incremental value of thoracic ultrasound in intensive care units: Indications, uses, and applications

Liccardo

Martone

Trambaiolo

et al. 2016

WJR

View full text Add to dashboard Cite

Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations. B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago. Its application in the diagnosis of thoracic diseases has always been considered limited, due to the presence of air in the lung and the presence of the bones of the thoracic cage, which prevent the progression of the ultrasound beam. However, the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly "water-rich" or "air-rich". The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review. Core tip: The close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of Liccardo B et al . Thoracic ultrasound in ICU the various varieties of pulmonary pathologic diseases which are predominantly "water-rich" or "air-rich". The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.

show abstract

Bedside Ultrasonography in the ICU

Cited by 144 publications

References 137 publications

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects

Morbid Obesity and Optimization of Preoperative Fluid Therapy

Incremental value of thoracic ultrasound in intensive care units: Indications, uses, and applications

Contact Info

Product

Resources

About