By Parag Desai, MD
Ultrasonography has become a valuable tool in the management of critically ill and injured patients. It is routinely incorporated into most trauma and emergency medicine care and is now gaining a foothold in care of the ICU patient.Ultrasonography provides a dynamic window into the human body, allowing for enhanced patient evaluations and examinations across organ systems. It can be applied easily and repeatedly, with real-time feedback that can lead to relevant changes in the clinical management of the patient.
There are several applications of ultrasonography in critically ill patients at bedside. Ultrasonographic lung examination allows for assessing lung aeration and complications related to cardiogenic and non-cardiogenic pulmonary edema; pleural evaluation; guidance of thoracentesis; and pneumothorax identification and treatment. Clinicians can conduct ocular assessments of globe rupture and increased intracranial pressure. Bedside cardiac ultrasound can help determine global cardiac function and help elucidate causes of shock; it can be applied in various ways for fluid assessment. Vascular ultrasound, as traditionally practiced for placement of central venous catheters, can now be expanded for examination of the aorta and inferior vena cava; in addition, a rapid venous assessment can be performed for identification of deep vein thrombosis. Abdominal ultrasound can help identify ascites and provide a guided approach to paracentesis; in trauma or shock applications, one can visualize the spleno-renal and hepato-renal recesses for fluid collection and also assess the bladder.
Bedside ultrasound has become an integral part of care of the critically ill patient, just like the physical examination and the stethoscope. It has its limitations, including the cost of the machine and the requisite learning process. However, it will likely become a required standard-of-care tool. Intensivists and pulmonologists should continually use the technology and take courses to gain comfort and familiarity with this tool. ■