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Ultrasound And Critical Care

Michael Schreiber, Clemens-Alexander Greim
The rising impact of perioperative sonography is mainly based on mobile high quality ultrasound systems. Relevant bleedings or functional limitations of the abdomen are easy to identify with sonography. The FAST-Concept can be the first access to continue proceedings in ultrasound examination of the abdomen. This paper demonstrates some important ultrasound examinations of the abdomen. The clinical main issues are traumatic and atraumatic bleedings of heart, liver and spleen with haemodynamic instability and functional limitations of abdominal organs like bile cystitis, gastrointestinal passage disability and obstructive uropathy...
February 2019: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Paru Patrawalla, Mangala Narasimhan, Lewis Eisen, Ariel L Shiloh, Seth Koenig, Paul Mayo
OBJECTIVE: Training in critical care ultrasonography is an essential tool in critical care medicine and recommended for fellowship programs in pulmonary and critical care medicine. Major barriers to implementing competency-based training in individual fellowship programs include a lack of expert faculty, time, and funding. Our objective was to investigate whether regional collaboration to deliver an introductory critical care ultrasonography course for fellows might overcome these barriers while achieving international training standards...
February 12, 2019: Journal of Intensive Care Medicine
Megan Finch-Edmondson, Catherine Morgan, Rod W Hunt, Iona Novak
Worldwide, an estimated 15 million babies are born preterm (<37 weeks' gestation) every year. Despite significant improvements in survival rates, preterm infants often face a lifetime of neurodevelopmental disability including cognitive, behavioral, and motor impairments. Indeed, prematurity remains the largest risk factor for the development of cerebral palsy. The developing brain of the preterm infant is particularly fragile; preterm babies exhibit varying severities of cerebral palsy arising from reductions in both cerebral white and gray matter volumes, as well as altered brain microstructure and connectivity...
2019: Frontiers in Physiology
Adel Elkbuli, John D Ehrhardt, Shaikh Hai, Mark McKenney, Dessy Boneva
INTRODUCTION: Urinary bladder ruptures are an uncommon injury, occurring in less than 1% of all blunt abdominal trauma. Extraperitoneal bladder ruptures are generally associated with pelvic fractures and usually managed nonoperatively. Conversely, intraperitoneal injuries are often caused by large compressive and shear forces produced during seatbelt injuries and almost invariably require surgical intervention. PRESENTATION OF CASE: A 29-year-old woman presented as a trauma alert after a motor vehicle collision with abdominal/flank pain and gross hematuria...
February 1, 2019: International Journal of Surgery Case Reports
Robert Patejdl, Uwe Walter, Sarah Rosener, Martin Sauer, Daniel A Reuter, Johannes Ehler
BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is associated with poorer outcome of critically ill patients. Microcirculatory changes and altered vascular permeability of skeletal muscles might contribute to the pathogenesis of ICU-AW. Muscular ultrasound (MUS) displays increased muscle echogenicity, although its pathogenesis is uncertain. OBJECTIVE: We investigated the combined measurement of serum and ultrasound markers to assess ICU-AW and clinical patient outcome...
February 11, 2019: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Joshua R Radparvar, George Lim, Alan T Chiem
OBJECTIVES: As point of care ultrasound (POCUS) has become more integrated into emergency and critical care medicine, there has been increased interest in utilizing ultrasound to assess volume status. However, recent studies of carotid POCUS on volume status and fluid responsiveness fail to recognize the effect insonation angle has on their results. To address this, we studied the effect of insonation angle on peak systolic velocity (PSV) change associated with respiratory variation (RV) and passive leg raise (PLR)...
January 29, 2019: American Journal of Emergency Medicine
Zouheir Ibrahim Bitar, Ossama Sajeh Maadarani, AlAsmar Mohammed El-Shably, Mubarak Juwaied Al-Ajmi
Background and aims: Chest radiography (CXR) and computerized tomography (CT) scan are the preferred methods for lung imaging in diagnosing pneumonia in the intensive care unit, in spite of their limitations. The aim of this study was to assess the performance of bedside lung ultrasound examination by a critical care physician, compared with CXR and chest CT, in the diagnosis of acute pneumonia in the ICU. Materials and Methods: This was an observational, prospective, single-center study conducted in the intensive care unit of Ahmadi General Hospital...
January 2019: Health science reports
Christian D Becker, Mario V Fusaro, Corey Scurlock
PURPOSE OF REVIEW: The evidence base for telemedicine in the ICU (tele-ICU) is rapidly expanding. The last 2 years have seen important additions to our understanding of when, where, and how telemedicine in the ICU adds value. RECENT FINDINGS: Recent publications and a recent meta-analysis confirm that tele-ICU improves core clinical outcomes for ICU patients. Recent evidence further demonstrates that comprehensive tele-ICU programs have the potential to quickly recuperate their implementation and operational costs and significantly increase case volumes and direct contribution margins particularly if additional logistics and care standardization functions are embedded to optimize ICU bed utilization and reduce complications...
January 28, 2019: Current Opinion in Anaesthesiology
Luigi Vetrugno, Giovanni Maria Guadagnin, Federico Barbariol, Nicola Langiano, Alberto Zangrillo, Tiziana Bove
Of the various muscles that make up the respiratory system, the diaphragm is the prima donna. In the past, only specialist research centers were able to estimate and challenge the effort of this muscle; this was achieved by measuring transdiaphragmatic pressure-an invasive technique involving a double-balloon probe inserted through the esophagus-or by measuring twitch pressure (ie, the pressure generated at the outside tip of the endotracheal tube). However, the prevalence of diaphragm dysfunction in critically ill patients requiring intubation can exceed 60% (at the time of hospital admission) and may rise to as high as 80% in patients requiring prolonged mechanical ventilation and experiencing difficult weaning...
January 4, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Maged Labib Boules
Background: Vascular access is a top priority in the critically ill patients. Cannulation - venous and/or arterial - is the first step in any emergency situation. Ultrasound (US)-guided vascular cannulation was found to have a higher success rate and a decreased incidence of mechanical complications as compared with the landmark one. Aim: This study aims to compare subclavian vein (SCV) access through supraclavicular (SC) approach by endocavitary (EC) probe technique versus linear array high-frequency probe technique...
October 2018: Anesthesia, Essays and Researches
Manjush Karthika, Duane Wong, Suresh G Nair, Lalitha V Pillai, Chris Sara Mathew
Lung ultrasound is a point-of-care imaging tool that is routinely used in acute care medicine. Traditionally, radiology physicians were the primary practitioners of diagnostic ultrasound, but with the recognition of its importance in intensive care medicine, critical care physicians have also adopted this practice. Within the intensive care unit inter-professional team is the respiratory therapist, who participates actively in the care of ventilated patients. Their scope of responsibility is expanding with newer technologies being brought into clinical use on a regular basis...
February 2019: Respiratory Care
Adrian Wong, Laura Galarza, Frantisek Duska
OBJECTIVES: Critical care ultrasonography has become established within ICUs as a diagnostic tool and to guide management strategies and practical procedures. Following an international consensus statement in 2011, various national professional societies and organizations have sought to develop and deliver training programmes. The aim of this review was to assess the similarities and differences among these postgraduate intensive care/critical care training programmes. DATA SOURCES: A systematic review was performed in two steps...
January 10, 2019: Critical Care Medicine
Mridul Dhar, Yashwant S Payal, Vamshi Krishna
Ultrasonography (USG) has a continuously expanding role in anaesthesiology, critical care and pain management and has enhanced and refined patient care. The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act was established to counter the persistent problem of female foeticide in India. This unique problem which seems to be rooted in our social structure has indirectly impeded the evolution of USG as a widespread tool in medicine in our country. This brief review is aimed at highlighting the expanding role of USG in anaesthesia practice and training, nuances of the PCPNDT act and its implications on the growth and management of ultrasound technology in anaesthesia, in India...
December 2018: Indian Journal of Anaesthesia
Naveed Ur Rehman Siddiqui, Anwarul Haque, Qalab Abbas, Humaira Jurair, Basit Salam, Raza Sayani
Background: Intracranial hypertension is not an uncommon life-threatening syndrome, caused by a variety of non-neurological and neurological illnesses, and quick diagnosis, timely treatment of Raised Intracranial Pressure (ICP) is associated with improved outcome. Our aim of study was to determine ultrasonographic measurement of Optic nerve sheath diameter (ONSD) for raised ICP. Methods: Prospective case series done in Emergency and Paediatric critical care unit of Aga Khan University Hospital...
October 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Emily Leibenguth, Kathy Magdic, Vicki Loeslie, Hemang Yadav, Jane Guttendorf
BACKGROUND AND PURPOSE: The use of pulmonary ultrasound (US) in the critical care setting has been increasing over the past 2 decades. The use of advanced practice providers (APPs) in the critical care setting is also increasing. Limited data exist regarding the clinical and educational impact of a formal pulmonary US training course for APPs working in critical care settings. METHODS: A preimplementation and postimplementation comparative design focused on the development and implementation of a formal pulmonary US course for novice critical care APPs...
January 4, 2019: Journal of the American Association of Nurse Practitioners
Sigrid Beitland, Henning Wimmer, Torleif Lorentsen, Dag Jacobsen, Tomas Draegni, Cathrine Brunborg, Nils Einar Kløw, Per Morten Sandset, Kjetil Sunde
BACKGROUND: The aim of the study was to explore occurrence, risk factors and outcome of venous thromboembolism (VTE) in intensive care unit (ICU) patients. METHODS: Prospective observational study of ICU patients receiving thromboprophylaxis at Oslo University Hospital in Norway. Adult medical and surgical patients with ICU length of stay (LOS) longer than 48 hours were included. For detection of VTE, Doppler ultrasound screening of neck, upper and lower extremity veins was used, and computed tomography angiography when clinically indicated for any medical reason...
January 8, 2019: Acta Anaesthesiologica Scandinavica
Joerg C Schefold, Anna S Messmer, Stefanie Wenger, Lionel Müller, Stephan von Haehling, Wolfram Doehner, Jamie S McPhee, Michaela Fux, Kai M Rösler, Olivier Scheidegger, Radu Olariu, Werner Z'Graggen, Serge Rezzi, Dominik Grathwohl, Tobias Konz, Jukka Takala, Bernard Cuenoud, Stephan M Jakob
INTRODUCTION: Intensive care unit-acquired weakness (ICU-AW) is often observed in critically ill patients with prolonged intensive care unit (ICU) stay. We hypothesized that evolving metabolic abnormalities during prolonged ICU stay are reflected by changing nutrient patterns in blood, urine and skeletal muscle, and that these patterns differ in patients with/without ICU-AW and between patients with/without sepsis. METHODS: In a prospective single-center observational trial, we aim to recruit 100 critically ill patients (ICU length of stay ≥ 5 days) with severe sepsis/septic shock ("sepsis group", n = 50) or severe head trauma/intracerebral hemorrhage ("CNS group", n = 50)...
January 2019: Medicine (Baltimore)
Wanhong Yin, Tongjuan Zou, Yao Qin, Jing Yang, Yi Li, Xueying Zeng, Yan Kang
BACKGROUND: The lung ultrasound score has been regarded as a decent semiquantitative score to measure the lung aeration loss. The score has been proven to be valuable in diagnosing and monitoring lung pathology, but no studies have demonstrated its relationship to the outcome. We aimed to investigate the relationship between the lung ultrasound score and outcome in shock patients in the Intensive Care Unit. METHODS: The data were extracted from the SHOCK-ICU study, a 14-month prospective study of shock patients in the Medical Intensive Care Unit in West China Hospital...
January 3, 2019: BMC Pulmonary Medicine
Saurabh Saigal, Rajnish Joshi, Jai Prakash Sharma, Vandana Pandey, Abhijit Pakhare
Introduction: The objective of this study was to classify dyspneic patients and to evaluate outcome variables on the basis of lung ultrasound (LUS) and arterial blood gas (ABG) findings. Methods: We performed a retrospective chart-based review in which we included patients with dyspnea admitted to our intensive care unit (ICU) between March 2015 and August 2016. On the basis of LUS (presence of A-lines/B-lines) and ABG (hypoxia/hypercarbia), patients were classified into six groups: (i) metabolic defect (dry lung, no hypoxia); (ii) perfusion defect (dry lung, hypoxia); (iii) ventilation defect (dry lung, hypoxia, and hypercarbia); (iv) ventilation and alveolar defect (wet lung, hypoxia, and hypercarbia); (v) alveolar defect-consolidation ([wet lung] hypoxia, no echocardiographic [ECG] abnormality); (vi) alveolar defect-pulmonary edema (wet lung [usually bilateral], hypoxia, ECG abnormality)...
November 2018: Indian Journal of Critical Care Medicine
Yeshaswini Katari, Rangalakshmi Srinivasan, Priyadarshini Arvind, Sahajananda Hiremathada
Background: Muscular atrophy is the universal feature in patients with ICUAW. Muscles of the lower limb are more prone to early atrophy. Measurement of fat thickness is used to assess malnutrition. This study was designed to evaluate if, subcutaneous fat also reduces along with muscle thickness and if it can be reliably used as an indicator of nutritional assessment in critically ill patients using point of care ultrasound. Materials and Methods: An observational clinical study of 100 patients admitted to multidisciplinary intensive care units (ICUs)...
November 2018: Indian Journal of Critical Care Medicine
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