Acute and Critical Care

Original Articles

Nutrition
Effect of standard- versus high-protein enteral feeding on rectus femoris muscle mass in mechanically ventilated traumatic brain injury: prospective randomized study: Hanan Elkalawy, Pavan Sekhar, Mona Fayad, Mohamed Barrima, Mohammad Abdullah; Received March 25, 2025 Accepted September 10, 2025 Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.001025 [Epub ahead of print]

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Abstract PDF: Background
Critically ill patients with muscle wasting experience prolonged intensive care unit (ICU) stays, delayed weaning, and higher mortality. Trauma-induced stress disrupts protein metabolism, leading to immunosuppression and muscle loss. This study evaluates whether high-protein intake through enteral nutrition preserves muscle mass and improves clinical outcomes compared to standard protein intake.
Methods
In our multicenter research, 102 critically ill, mechanically ventilated patients (age, 39±7; female, 52; body mass index, 23.8±2.7 kg/m2) were assigned randomly to receive either a high-protein (2.2 g/kg BW/day) or standard (1.5 g/kg BW/day) diet. Enteral nutrition was individualized based on energy expenditure. Ultrasound measured whether the rectus femoris muscle cross-sectional area (RFM-9 CSA) and pennation angle correlated with dietary intake. The data are presented as mean±standard deviation.
Results
Protein intake was 1.8±0.2 vs. 1.2±0.4 g/kg/day in high-protein and standard groups, respectively. In the intervention and standard groups, the baseline RFM-CSA and Pennation angle were 11.43±0.87 mm vs. 11.3±0.91 mm and 9.1±0.58 mm vs. 8.91±1.04 mm (P>0.05). Days 5, 10, and 20 showed significant variations in RFM-CSA and pennation angle (P<0.001). The intervention group experienced a shorter ICU length of stay (47±19.5 vs. 56.3±26.9 days, P=0.001) and a shorter period of mechanical ventilation (33±2.3 vs. 30±3.5 days, P=0.001).
Conclusions
Early high protein intake significantly preserves muscle mass, reducing the duration of stay in the ICU and the need for mechanical ventilation.

Trauma
The correlation between carotid artery Doppler and stroke volume during central blood volume loss and resuscitation: Isabel Kerrebijn, Sarah Atwi, Mai Elfarnawany, Andrew M. Eibl, Joseph K. Eibl, Jenna L. Taylor, Chul Ho Kim, Bruce D. Johnson, Jon-Émile S. Kenny; Acute Crit Care. 2024;39(1):162-168. Published online February 23, 2024; DOI: https://doi.org/10.4266/acc.2023.01095

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Background
Using peripheral arteries to infer central hemodynamics is common among hemodynamic monitors. Doppler ultrasound of the common carotid artery has been used in this manner with conflicting results. We investigated the relationship between changing common carotid artery Doppler measures and stroke volume (SV), hypothesizing that more consecutively-averaged cardiac cycles would improve SV-carotid Doppler correlation.
Methods
Twenty-seven healthy volunteers were recruited and studied in a physiology laboratory. Carotid artery Doppler pulse was measured with a wearable, wireless ultrasound during central hypovolemia and resuscitation induced by a stepped lower body negative pressure protocol. The change in maximum velocity time integral (VTI) and corrected flow time of the carotid artery (ccFT) were compared with changing SV using repeated measures correlation.
Results
In total, 73,431 cardiac cycles were compared across 27 subjects. There was a strong linear correlation between changing SV and carotid Doppler measures during simulated hemorrhage (repeated-measures linear correlation [Rrm ]=0.91 for VTI; 0.88 for ccFT). This relationship improved with larger numbers of consecutively-averaged cardiac cycles. For ccFT, beyond four consecutively-averaged cardiac cycles the correlation coefficient remained strong (i.e., Rrm of at least 0.80). For VTI, the correlation coefficient with SV was strong for any number of averaged cardiac cycles. For both ccFT and VTI, Rrm remained stable around 25 consecutively-averaged cardiac cycles.
Conclusions
There was a strong linear correlation between changing SV and carotid Doppler measures during central blood volume loss. The strength of this relationship was dependent upon the number of consecutively-averaged cardiac cycles.

Citations

Citations to this article as recorded by

The feasibility of monitoring trauma patients with a wireless, wearable Doppler ultrasound
Luis Da Luz, Sarah Atwi, Lowyl Notario, Rachael Irvine, Diane Farah, Delaney Johnston, Jon‐Emile S. Kenny, Joseph K. Eibl, Dylan Pannell
Transfusion.2025;[Epub] CrossRef
Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass Grafting
Jon-Emile S. Kenny, Geoffrey Clarke, Sarah Atwi, Isabel Kerrebijn, Tracy Savery, Meredith Knott, Chelsea E. Munding, Mai Elfarnawany, Andrew M. Eibl, Joseph K. Eibl, Bhanu Nalla, Rony Atoui
CHEST Critical Care.2025; 3(2): 100138. CrossRef

Review Articles

Surgery
Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review: Hanan Elkalawy, Pavan Sekhar, Wael Abosena; Acute Crit Care. 2023;38(4):409-424. Published online November 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00703

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Abstract PDF

Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.

Citations

Citations to this article as recorded by

Nursing-based precision assessment of nutrition and muscle status without ultrasound: a prospective observational study in mechanically ventilated neurosurgical patients
Chenliang Pan, Dingding Xu, Zixin Wang, Jia Wen, Lili Ma, Yajuan Zhang
Frontiers in Medicine.2026;[Epub] CrossRef
Advancing Nutritional Care Through Bioelectrical Impedance Analysis in Critical Patients
Ana Maria Dumitriu, Cristian Cobilinschi, Bogdan Dumitriu, Sebastian Vâlcea, Raluca Ungureanu, Angela Popa, Rǎzvan Ene, Radu Țincu, Ioana Marina Grințescu, Liliana Mirea
Nutrients.2025; 17(3): 380. CrossRef
Potential diagnostic tools for intensive care unit acquired weakness: A systematic review
Chen Xin, Yubiao Gai, Lili Wei, Yanqiu Wang, Yuhong Luo, Binru Han
International Journal of Nursing Studies Advances.2025; 8: 100301. CrossRef
Relação entre a perda de massa magra, força muscular e capacidade funcional de pacientes críticos vítimas de trauma
Tamine Vitória Pereira Moraes, Renato Valduga , Priscilla Flávia de Melo Fernandes, Guilherme Duprat Ceniccola
Health Residencies Journal.2025;[Epub] CrossRef
Development and validation of machine learning-based risk prediction models for ICU-acquired weakness: a prospective cohort study
Yimei Zhang, Yu Wang, Jingran Yang, Qinglan Li, Min Zhou, Jiafei Lu, Qiulan Hu, Fang Ma
European Journal of Medical Research.2025;[Epub] CrossRef
Diagnostic Innovations to Combat Antibiotic Resistance in Critical Care: Tools for Targeted Therapy and Stewardship
Ahmed D. Alatawi, Helal F. Hetta, Mostafa A. Sayed Ali, Yasmin N. Ramadan, Amirah B. Alaqyli, Wareef K. Alansari, Nada H. Aldhaheri, Talidah A. Bin Selim, Shahad A. Merdad, Maram O. Alharbi, Wejdan Alhumaidi Hmdan Alatawi, Abdelazeem M. Algammal
Diagnostics.2025; 15(17): 2244. CrossRef
Early skeletal muscle loss and clinical outcomes in critically ill patients in the medical intensive care unit: A retrospective cohort study
Soyun Kim, Da Hyun Kang, Dukki Kim, Soyoung Ahn, Mi Ra Lee, Song Lee, Masoud Rahmati
PLOS One.2025; 20(12): e0338315. CrossRef
The role of bioimpedance in determining protein intake after ICU care
Cristian Deana, Alessia Marin, Michele Umbrello, Daniele Guerino Biasucci, Laura Di Meo, Luigi Vetrugno
Clinical Nutrition Open Science.2025; 64: 230. CrossRef
Characteristics of the Cerebrospinal Fluid in Septic Patients with Critical Illness Polyneuropathy - A Retrospective Cohort Study
Yanyang Zhang, Jinfu Ma, Qing Zhao, Hui Liu
The Journal of Critical Care Medicine.2024; 10(2): 130. CrossRef
Advancing critical care recovery: The pivotal role of machine learning in early detection of intensive care unit-acquired weakness
Georges Khattar, Elie Bou Sanayeh
World Journal of Clinical Cases.2024; 12(21): 4455. CrossRef
Construction and evaluation of acquired weakness nomogram model in patients with mechanical ventilation in intensive care unit
Chen Lu, Jiang Wenjuan
DIGITAL HEALTH.2024;[Epub] CrossRef
A scoping review of preclinical intensive care unit-acquired weakness models
Qingmei Yu, Jiamei Song, Luying Yang, Yanmei Miao, Leiyu Xie, Xinglong Ma, Peng Xie, Shaolin Chen
Frontiers in Physiology.2024;[Epub] CrossRef

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.

Citations

Citations to this article as recorded by

Lung Ultrasound—A Supplementary Tool for the Diagnosis of Pulmonary Tuberculosis in Children
Vinita Rathi, Raveena Rawat, Sumit Kumar, Amol Srivastava, Anupama Tandon
Journal of Clinical Ultrasound.2025; 53(4): 700. CrossRef
Usefulness of Ultrasonography for the Evaluation and Management of Lung Abscess in Pediatric Patients
Takahiro Hosokawa, Kuntaro Deguchi, Haruka Takei, Yumiko Sato, Yutaka Tanami, Kyoichi Deie, Hiroshi Kawashima, Eiji Oguma
Journal of Ultrasound in Medicine.2025; 44(11): 2091. CrossRef
Focus ultrasound in patients with ST-elevation myocardial infarction during initial physical examination
A. V. Kostin, D. V. Skrypnik
Medical alphabet.2024; (22): 35. CrossRef

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.

Citations

Citations to this article as recorded by

Point-of-Care Ultrasound, an Integral Role in the Future of Enhanced Recovery After Surgery?
Peter Van de Putte, An Wallyn, Rosemary Hogg, Lars Knudsen, Kariem El-Boghdadly
Anesthesia & Analgesia.2025; 140(5): 1114. CrossRef
A Muscle-Driven Spine Model for Predictive Simulations in the Design of Spinal Implants and Lumbar Orthoses
Robin Remus, Andreas Lipphaus, Marisa Ritter, Marc Neumann, Beate Bender
Bioengineering.2025; 12(3): 263. CrossRef
Diaphragm Ultrasound for Assessing Diaphragmatic Function and Predicting Ventilator Weaning Success: A Review of the Literature
Gulus Emre, Daniel Acosta, Cameron Baston
Current Pulmonology Reports.2025;[Epub] CrossRef
Ultrasonography to Access Diaphragm Dysfunction and Predict the Success of Mechanical Ventilation Weaning in Critical Care
Marta Rafael Marques, José Manuel Pereira, José Artur Paiva, Gonzalo García de Casasola‐Sánchez, Yale Tung‐Chen
Journal of Ultrasound in Medicine.2024; 43(2): 223. CrossRef
Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis
Diego Poddighe, Marine Van Hollebeke, Yasir Qaiser Choudhary, Débora Ribeiro Campos, Michele R. Schaeffer, Jan Y. Verbakel, Greet Hermans, Rik Gosselink, Daniel Langer
Critical Care.2024;[Epub] CrossRef
Ultrasonographic evaluation of diaphragm thickness and excursion: correlation with weaning success in trauma patients: prospective cohort study
Golnar Sabetian, Mandana Mackie, Naeimehossadat Asmarian, Mahsa Banifatemi, Gregory A. Schmidt, Mansoor Masjedi, Shahram Paydar, Farid Zand
Journal of Anesthesia.2024; 38(3): 354. CrossRef
Diaphragm muscle parameters as a predictive tool for weaning critically ill patients from mechanical ventilation: a systematic review and meta-analysis study
Yashar Iran Pour, Afrooz Zandifar
European Journal of Translational Myology.2024;[Epub] CrossRef
Diaphragm dysfunction as a prognostic criterion of external respiratory impairment and necessary extracorporeal membrane oxygenation in patients with chronic heart failure
V.S. Shabaev, V.A. Mazurok, L.Z. Biktasheva, L.G. Vasilyeva, K.Yu. Kozhieva, I.A. Danilova, N.A. Osipova
Russian Journal of Anesthesiology and Reanimatology.2024; (6): 38. CrossRef
Diaphragmatic ultrasound: A new frontier in weaning from mechanical ventilation
Manoj Kamal, Saikat Sengupta
Indian Journal of Anaesthesia.2023; 67(Suppl 4): S205. CrossRef

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; Acute Crit Care. 2025;40(1):144-149. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00045

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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 paraclinoid aneurysms. A 20-year-old male was 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) was 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 deserves 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.

Review Articles

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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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

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Dry Medical Thoracoscopy with Artificial Pneumothorax Induction Using Veress Needle
Nai-Chien Huan, Sze Shyang Kho, Larry Ellee Nyanti, Hema Yamini Ramarmuty, Muhammad Aklil Abd Rahim, Rong Lih Ho, Shan Min Lo, Siew Teck Tie, Kunji Kannan Sivaraman Kannan
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Lung Ultrasound as a Tool for Analysis of Ventilation in Children With Respiratory Failure
Ana Caroline Dos Santos Calandrini, Emmerson Carlos Franco De Farias, Mary Lucy Ferraz Maia, Katiane Da Costa Cunha, Rodrigo Santiago Barbosa Rocha
Journal of Clinical Ultrasound.2025; 53(5): 969. CrossRef
The Effect of Tidal Volumes of Mechanically Ventilated Patients on Lung Sliding Amplitude in Point‐Of‐Care Lung Ultrasound
İlker Şirin, Ahmet Burak Erdem, Şerife Büşra Uysal, Şeyda Gedikaslan
Journal of Clinical Ultrasound.2025; 53(5): 989. CrossRef
The Role of Lung Sliding Amplitude in Mechanical Ventilation Settings: A Step Forward in Personalized Medicine
Luigi Vetrugno, Antonio Corvino, Daniele Guerino Biasucci
Journal of Clinical Ultrasound.2025; 53(6): 1373. CrossRef
Evolving role of point-of-care ultrasound in prehospital emergency care: a narrative review
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Ghislaine Douflé, Laura Dragoi, Diana Morales Castro, Kei Sato, Dirk W. Donker, Nadia Aissaoui, Eddy Fan, Hannah Schaubroeck, Susanna Price, John F. Fraser, Alain Combes
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Ozlem Sogukpinar, Ulku Aka Akturk, Makbule Ozlem Akbay, Erdal Tatlidil, Dilek Ernam
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Transthoracic needle biopsy for diagnosis of lung cancer
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Journal of the Korean Medical Association.2023; 66(3): 160. CrossRef
Determinants of point-of-care ultrasound lung sliding amplitude in mechanically ventilated patients
David N. Briganti, Christine E. Choi, Julien Nguyen, Charles W. Lanks
The Ultrasound Journal.2023;[Epub] CrossRef
Humán kadávermodell a légmell ágy melletti ultrahang-diagnosztikájához.
Noémi Ádám, Gábor Orosz, Máté Berczi, Tamás Ruttkay
Orvosi Hetilap.2023; 164(46): 1824. CrossRef
Ultrasonography in cardiopulmonary emergencies
Kiran Kumar Gudivada, Bhuvana Krishna, Shiva Kumar Narayan
Lung India.2023; 40(3): 260. CrossRef
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
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Indian Journal of Respiratory Care.2020; 9(2): 141. CrossRef
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Role of thoracic ultrasound in children with chronic kidney disease
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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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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.

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Intraoperative Lung Ultrasound in the Detection of Pulmonary Nodules: A Valuable Tool in Thoracic Surgery
Diana Yasin, Jalal Al Khateeb, Dina Sbeih, Firas Abu Akar
Diagnostics.2025; 15(9): 1074. CrossRef
Pulmonary ultrasound versus chest radiography in the diagnosis of community-acquired pneumonia in adults: an updated systematic review and meta-analysis
Víctor Juan Vera-Ponce, Jhosmer Ballena-Caicedo, Juan Carlos Bustamante-Rodríguez, Fiorella E. Zuzunaga-Montoya, Luisa Erika Milagros Vásquez-Romero, Joan A. Loayza-Castro, Mario J. Valladares-Garrido, Carmen Inés Gutierrez De Carrillo, Felix Llanos Tejad
Respiratory Medicine and Research.2025; 88: 101200. CrossRef
Lung Ultrasound in the ICU: Strengths, Limitations, and the Continued Role of Computed Tomography
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Indian Journal of Critical Care Medicine.2025; 29(12): 1054. CrossRef
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Haneen Mallah, Ahmad AL-Tanjy, Muhannad Mahmoud, Lina Alkhdour, Leen Amro, Abdallah Alshurafa, Mu’taz Alshaikh Hasan, Bashar Alzghoul
JAP Academy Journal.2024;[Epub] CrossRef
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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
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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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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

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