Ultrasonography in the Critical Care Unit
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ECHOCARDIOGRAPHY (JM GARDIN AND AH WALLER, SECTION EDITORS)
Ultrasonography in the Critical Care Unit Keith Guevarra 1
&
Yonatan Greenstein 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This article summarizes the utility and evidence supporting the use of ultrasound exams in the intensive care unit. Recent Findings Point-of-care ultrasonography (POCUS) is widely used by intensivists managing critically ill patients whereby they can accurately and rapidly assess for many pathologies such as pneumothorax, pulmonary edema, hydronephrosis, hemoperitoneum, and deep vein thrombosis among others. Basic and advanced critical care echocardiography, including transesophageal echocardiography, are routinely performed to determine the etiology of hemodynamic instability in undifferentiated shock and to guide subsequent therapy. The use of POCUS in the assessment of volume status is controversial with studies demonstrating that respiratory variation of the IVC is not reliable and with analysis of aortic blood flow velocity after passive leg raising maneuvers being the most promising. Summary Point-of-care ultrasonography allows frontline clinicians to make real-time diagnoses and treatment decisions. This article will provide the reader with a broad overview of this important topic. Keywords Critical care ultrasonography . Point-of-care ultrasonography . Intensivist . Echocardiography . POCUS
Introduction Point-of-care ultrasonography (POCUS) has rapidly become a diagnostic tool used by frontline clinicians taking care of critically ill patients. This modality includes sonography of the heart, lungs, abdomen, kidneys, and vascular system. It incorporates diagnostic assessments and procedural guidance. It distinguishes itself from traditional ultrasonography studies in that the frontline clinician managing the critically ill patient is obtaining the images on their own and interpreting them in
real time for immediate clinical decision making. Point-ofcare ultrasonography enables the clinician to quickly identify a multitude of life-threatening entities, to guide the management of hemodynamically unstable patients, and is standard of care for procedural guidance. Our standard practice is to perform a whole body ultrasonography study on each patient presenting with hemodynamic instability [1••, 2]. This review will focus on the use of POCUS in the intensive care unit (ICU) and will highlight the emerging use of advanced echocardiographic techniques in addition to addressing issues of competency and credentialing.
This article is part of the Topical Collection on Echocardiography Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11886-020-01393-z) contains supplementary material, which is available to authorized users. * Keith Guevarra [email protected] Yonatan Greenstein [email protected] 1
Department of Medicine, Division of Pulmonary and Critical Care Medicine and Allergy and Rheumatology, Rutgers – New Jersey M
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