Outline the potential roles for the use of ultrasound in the critically ill patient.

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College Answer

Roles include –

Cardiac echo – be it transthoracic or transoesophageal looking at structure, function, relationships between the two ventricles and pericardial effusions. Doppler cardiac output monitoring – oesophageal, transthoracic

Vascular – specifically thoracic aorta – but also abdominal aorta. Other vascular include any accessible artery (eg radial, brachial, femoral, carotid etc), grafts for flow assessment, stenosis, patency. Also veins – for thrombosis/patency

Cranial – monitor cerebral blood flow hyperaemia, ischaemia, brain death, detection of vasospasm, fat and other emboli, stroke related artery reperfusion following thrombolysis.

Other –pleural, diaphragm etc

Diagnostic ultrasound, esp abdomen – identify bladder (urinary retention), biliary anatomy, including gallbladder important to mention acalculous cholecystitis, atelectasis, pneumothorax

Ultrasound assisted interventions (drainage of collections)

Vessel identification for line insertion

Discussion

A nice article about the use of ultrasound in the ICU can be found in Continuing Education in Anaesthesia, Critical Care & Pain (Wilson and Mackay, 2012).

This question can be approached systematically; the answer presented below has been modelled on Table 1 from this article, and is organised by body area being examined:

  • Head:
    • Transcranial doppler in SAH-associated vasospasm and in confirmation of brain death
  • Neck
    • Central line insertion
  • Thoracic
    • Identification of pneumothorax
    • Localisation and ultrasound-guided aspiration of pleural effusions
  • Cardiac
    • Echocardiography (structure and function)
    • Ultrasound-guided pericardiocentesis
  • Abdominal
    • FAST
    • Solid organ pathology (eg. hydronephrosis, splenomegaly, cirrhosis)
    • Renal vascular flow
    • Gall bladder pathology
    • Portal vein pathology
    • Aortic pathology
  • Peripheral
    • Peripheral venous access
    • Peripheral arterial flow assessment
    • Assessment of DVTs

References

References

Wilson, Stephen, and Andrew Mackay. "Ultrasound in critical care." Continuing Education in Anaesthesia, Critical Care & Pain 12.4 (2012): 190-194.