Acute and Critical Care

Review Article

Pulmonary
Lung ultrasound for evaluation of dyspnea: a pictorial review: Aparna Murali, Anjali Prakash, Rashmi Dixit, Monica Juneja, Naresh Kumar; Acute Crit Care. 2022;37(4):502-515. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00780

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Abstract PDF Supplementary Material: Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency (BLUE) protocol which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE protocol to diagnose the commonly presenting causes of acute dyspnea.

Original Article

Pulmonary
The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience: Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, Mukesh Sharma, Dhruva Chaudhry; Acute Crit Care. 2022;37(3):347-354. Published online July 25, 2022; DOI: https://doi.org/10.4266/acc.2022.00108

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Abstract PDF Supplementary Material: Background
Acute respiratory failure (ARF) is commonly managed with invasive mechanical ventilation (IMV). The majority of the time that a patient spends on IMV is in the process of weaning. Prediction of the weaning outcome is of paramount importance, as untimely/delayed extubation is associated with a high risk of mortality. Diaphragmatic ultrasonography is a promising tool in the intensive care unit, and its utility in predicting the success of weaning remains understudied.
Methods
In this prospective-observational study, we recruited 54 ARF patients on IMV, along with 50 healthy controls. During a spontaneous breathing trial, all subjects underwent diaphragmatic ultrasonography along with a rapid shallow breathing index (RSBI) assessment.
Results
The mean age was 41.8±17.0 and 37.6±10.5 years among the cases and control group, respectively. Demographic variables were broadly similar in the two groups. The most common cause of ARF was obstructive airway disease. The average duration of IMV was 5.41±2.81 days. Out of 54 subjects, 45 were successfully weaned, while nine patients failed weaning. Age, body mass index, and severity of disease were similar in the successful and failed weaning patients. The sensitivity in predicting successful weaning of percent change in diaphragmatic thickness (Δtdi%) >29.71% was high (93.33%), while specificity was 66.67%. The sensitivity and specificity of mean diaphragmatic thickness (tdi) end-expiratory >0.178 cm was 60.00% and 77.78%, respectively. RSBI at 1 minute of <93.75 had an equally high sensitivity (93.33%) but a lower specificity (22.22%). Similar results were also found for RSBI measured at 5 minutes.
Conclusions
During the weaning assessment, the purpose is to minimize both premature as well as delayed extubation. We found that diaphragmatic ultrasonography, in particular Δtdi%, is better than RSBI in predicting weaning outcomes.

Case Report

Neurosurgery
A point-of-care evaluation after visual loss following paraclinoid aneurysm repair: the role of sonographic and pupillometer assessment: Giacomo Bertolini, Ernesto Migliorino, Diego Mazzatenta, Carlo Bortolotti, Raffaele Aspide; Received January 9, 2022 Accepted March 17, 2022 Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00045 [Epub ahead of print]

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Abstract PDF: Visual complications represent common deficits following surgical or endovascular repair of paraclinoid aneurysms. Different etiologies should be investigated to prevent devastating consequences. Herein we present a point-of-care evaluation to investigate sudden visual loss after coiling of a paraclinoid aneurysms. A 20-year-old male were admitted for a sudden headache. Head computed tomography showed a subarachnoid hemorrhage and subsequent angiography revealed a 9-mm left supraclinoid aneurysm of the internal carotid artery treated with endovascular coil embolization. Thirty minutes after intensive care unit admission the patient reported a left amaurosis. To exclude secondary etiologies an immediate evaluation with point-of-care devices (color-doppler and B-mode ultrasound and automated pupillometry) were performed. Sonographic evaluations were negative for ischemic/thrombotic events and neurologic pupil index within physiological ranges provide evidence of third cranial nerve responsiveness. The symptomatology resolved progressively over 120 minutes with low-dose steroid therapy, 30° head-of-bed elevation and blood pressure management. Visual deficits can occur after endovascular procedure and should be investigated. Suspected visual loss is a neurological emergency that deserve a prompt evaluation. Ultrasound and automated pupillometry have proved to be an effective, rapid, reliable and non-invasive combination for a clinical decision-making strategy in the management of post-procedural acute visual deficits.

Reviews

Pulmonary
Lung Ultrasound (in the Critically Ill) Superior to CT: the Example of Lung Sliding: Daniel A. Lichtenstein; Korean J Crit Care Med. 2017;32(1):1-8. Published online February 14, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00955

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9 Citations

Abstract PDF

This review article shows the potential of lung ultrasound in the critically ill (LUCI) to study lung sliding and describes the optimal equipment for its assessment. Then, it analyses the integration of lung sliding within lung ultrasound then whole body critical ultrasound. It describes the place of lung sliding in the BLUE-protocol (bedside lung ultrasound in emergency) (lung and venous ultrasound for diagnosing acute respiratory failure), the FALLS-protocol (fluid administration limited by lung sonography) (the role of lung sliding in circulatory failure), and the SESAME-protocol (sequential assessment of sonography assessing mechanism or origin of severe shock of indistinct cause) (whole body ultrasound in cardiac arrest). In the LUCIFLR project (LUCI favoring limitation of radiations), the consideration of lung sliding allows drastic reduction in irradiation and costs. In conclusion, lung sliding is proposed as a gold standard for indicating the presence of the lung at the chest wall and its correct expansion.

Citations

Citations to this article as recorded by

Early detection of delayed pneumothorax using lung ultrasound after transthoracic needle lung biopsy: A prospective pilot study
Jeong Suk Koh, Chaeuk Chung, Ju Ock Kim, Sung Soo Jung, Hee Sun Park, Jeong Eun Lee, Da Hyun Kang, Yoonjoo Kim, Dongil Park
The Clinical Respiratory Journal.2022; 16(5): 413. CrossRef
Usefulness of Lung Ultrasound Follow‐up in Patients Who Have Recovered From Coronavirus Disease 2019
Yale Tung‐Chen, Milagros Martí de Gracia, Maria Luz Parra‐Gordo, Aurea Díez‐Tascón, Sergio Agudo‐Fernández, Silvia Ossaba‐Vélez
Journal of Ultrasound in Medicine.2021; 40(9): 1971. CrossRef
The role of lung ultrasound in COVID-19 disease
Dirk-André Clevert, Paul S. Sidhu, Adrian Lim, Caroline Ewertsen, Vladimir Mitkov, Maciej Piskunowicz, Paolo Ricci, Núria Bargallo, Adrian P. Brady
Insights into Imaging.2021;[Epub] CrossRef
Point-of-Care Ultrasound in Acute Care Nephrology
Nithin Karakala, Daniel Córdoba, Kiran Chandrashekar, Arnaldo Lopez-Ruiz, Luis A. Juncos
Advances in Chronic Kidney Disease.2021; 28(1): 83. CrossRef
YEARS Algorithm Versus Wells’ Score
Ahmed Abdelaal Ahmed Mahmoud M. Alkhatip, Maria Donnelly, Lindi Snyman, Patrick Conroy, Mohamed Khaled Hamza, Ian Murphy, Andrew Purcell, David McGuire
Critical Care Medicine.2020; 48(5): 704. CrossRef
Sonographische Bildgebung der Lunge bei COVID-19
M. Schmid, F. Escher, D.-A. Clevert
Der Radiologe.2020; 60(10): 919. CrossRef
Current Misconceptions in Lung Ultrasound
Daniel A. Lichtenstein
Chest.2019; 156(1): 21. CrossRef
Role of thoracic ultrasound in children with chronic kidney disease
SaneyaAbd El-Halim Fahmy, NaglaaAbd El-Moneam Abd Allah, AmiraI Al-Masry, Eman Sobh
The Scientific Journal of Al-Azhar Medical Faculty, Girls.2019; 3(3): 693. CrossRef
Novel approaches to ultrasonography of the lung and pleural space: where are we now?
Daniel Lichtenstein
Breathe.2017; 13(2): 100. CrossRef

Pulmonary
Lung Ultrasound in Critically Ill Patients: Jinwoo Lee; Korean J Crit Care Med. 2016;31(1):4-9. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.4

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3 Citations

Abstract PDF

Lung ultrasound (LUS) is an emerging tool for intensivists to diagnose and monitor thoracic diseases of critically ill patients. It is easily applied at the bedside in real time and is free of radiation hazards. In the intensive care units (ICUs) lung ultrasound can be used to diagnose pneumothorax and interstitial syndrome. It can also be used to monitor changes in the lung. However, the major limitations of LUS is that it is highly operator dependent and cannot be applied in patients with thoracic dressings, subcutaenous emphysema or pleural calcifications. This article reviews the basic principles of lung ultrasound and discusses how it can be used in ICUs.

Citations

Citations to this article as recorded by

A comparative study between high-flow nasal oxygen therapy and venturi mask oxygen therapy for postoperative laparoscopic bariatric surgery patients with atelectasis: a randomized clinical trial
Asmaa Ahmed Nabeeh Negmeldin Abdelr Allam, Mayar Hassan Sayed Ahmed Elsersi, Galal Adel Mohamed Abdelreheem Elkady, Amr Fouad Hafez, Mohamed Abdelsalam Aly Algendy
Ain-Shams Journal of Anesthesiology.2022;[Epub] CrossRef
Efficacy of transalveolar pressure measurement as a monitoring parameter for lung recruitment in postcardiac surgery hypoxic patients
Ibrahim Mabrouk Ibrahim, Ahmed Yousef, Amal Sabry, Ayman Khalifa
Egyptian Journal of Anaesthesia.2021; 37(1): 145. CrossRef
Postoperative care of cardiac surgery patients: A protocolized approach towards enhanced recovery versus the conventional approach
Moustafa Ibrahim Abd EL-Aal Halwag, Mahar Ahmed Doghiem, Moustafa Abdelaziz Moustafa, Hossam Ossama Ahmed Sorour
Egyptian Journal of Anaesthesia.2021; 37(1): 410. CrossRef

Original Article

How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition: Hongjoon Ahn, Gundong Kim, Byulnimhee Cho, Wonjoon Jeong, Yeonho You, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo, Yongchul Cho; Korean J Crit Care Med. 2013;28(4):280-286.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.280

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3 Citations

Abstract PDF

BACKGROUND
The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED).
METHODS
We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05).
RESULTS
There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01).
CONCLUSIONS
The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.

Citations

Citations to this article as recorded by

Safety and Feasibility of Ultrasound-guided Peripherally Inserted Central Catheterization for Chemo-Delivery
Tak-Joong Song, Shin-Seok Yang, Woo-Sung Yoon
Journal of Surgical Ultrasound.2019; 6(1): 14. CrossRef
Single Center Experience of Ultrasonography-guided Bedside Procedures for Surgical Patients
Dooreh Kim, Dae Hyun Cho, Yun Tae Jung, Jae Gil Lee
Journal of Surgical Ultrasound.2018; 5(2): 61. CrossRef
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter
Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho
The Korean Journal of Critical Care Medicine.2015; 30(4): 280. CrossRef

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